The Texas Medical Board (TMB) is warning physicians and pharmacies of a scam involving criminals who sometimes pose as TMB officials. TMB passed along a report from the U.S. Drug Enforcement Administration (DEA) that says physicians registered with the DEA are receiving calls and emails from criminals who identify themselves as DEA personnel or other law enforcement agents.

New Patient Visit: Three Years Is a Key - 12/03/2021

Centers for Medicare & Medicaid Services auditors have identified claims coded for “new patient” evaluation and management services that don’t fit the definition for new patient services. Be sure to avoid this coding error.

Data Driven: Medicaid’s Inspector General Focuses on Fraud Prevention, Not Just Prosecution - 09/06/2021

Since her appointment in 2018, Texas Health and Human Services Inspector General Sylvia Hernandez Kauffman has homed in on using data analytics not only to prosecute fraud, waste, and abuse within the Medicaid program, but also to prevent it from happening in the first place. Texas Medicine spoke to Ms. Kauffman about what appears to be a shift in tone from this department as it also focuses on using the data it collects to educate physicians and other health care professionals on common billing mistakes.

How to Respond to a Medicare Audit - 08/27/2021

TMA Practice E-Tips editors ran across this excellent checklist of “17 tips from a lawyer” on how to respond to a Medicare audit.

Why, What, and Who Keys to Recoupment-Proof Documentation - 03/30/2021

The lack of a signature on specific portions of an otherwise complete documentation is enough to warrant a Medicare payment recoupment. Here’s what the Centers for Medicare & Medicaid Services found in three Comprehensive Error Rate Testing reviews.

Can’t Say It Enough: Document, Document, Document - 08/11/2020

When Medicare delves into claims errors, one stands out: insufficient documentation.

EHR Vendors Behaving Badly; What Can You Do? - 08/27/2018

Have you had a problem with your electronic health record vendor not following through on its contractual obligations? Many practices don’t know how or where to get help.

CMS to Expand Audits, Education Targeted to Outliers - 09/13/2017

A new type of audit may be coming your way, as the Centers for Medicare & Medicaid Services puts a pilot claims review program into practice nationwide.

Fraud, Waste, and Abuse Training: Not Just for Medicare Advantage Plans - 01/27/2017

Medicare requires annual fraud, waste, and abuse training for physicians contracted with any Medicare Advantage plan and their staff. But all practices should provide this type of training to all employees, regardless of health plan participation, says TMA.

Identify Your Own Fraud and Abuse Red Flags - 09/26/2016

One way to help keep your practice operations squeaky clean and in compliance with fraud and abuse laws is to develop an internal set of warning indicators.

Use Correct Surgery Modifiers in Medicare Claims - 05/13/2016

Medicare auditors working under the Recovery Audit program have identified significant payment errors related to surgery. Be sure to bill correctly using these modifiers.

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