Related Stories

Can’t Say It Enough: Document, Document, Document - 08/03/2020

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

Be On the Lookout for MIPS Audit Request - 06/25/2019

The Centers for Medicare & Medicaid Services has contracted with Guidehouse, a nationwide consulting firm, to audit physicians who participate in the Merit-Based Incentive Program, which is under the Quality Payment Program. If you submitted MIPS data for 2017 and/or 2018, you could receive a request for information via email or certified letter from Guidehouse.

HIPAA Privacy and Security Audits Coming Soon - 05/30/2019

A whole new round of audits — for compliance with HIPAA privacy requirements — are set to begin in early 2013.

Another Possible Audit, This Time for MIPS - 04/19/2018

You could receive a request in the future from the Centers for Medicare & Medicaid Services for an audit of your Merit-Based Incentive Payment System submissions.

Medicare Payments Cut? Apply for a Reconsideration Now - 02/07/2018

Some Texas physicians will incur a 3-percent cut on all 2018 Medicare Fee For Service charges because the Centers for Medicare & Medicaid Services believes they did not participate in the meaningful use program, TMA has learned. If you believe you are being penalized erroneously, you can submit a 2018 Payment Adjustment Reconsideration Application.

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.

Make a Penalty-Free Shift From Meaningful Use to MIPS - 06/14/2017

I’m confused about the overlap of dates between the meaningful use incentive program and the Advancing Care Information reporting requirements under the Merit-Based Incentive Payment System. Is there extra work for physicians who participate in both?

Meaningful Use Hardship Exemption Application Due by July 1 - 04/06/2017

Physicians who are not participating in the Medicare electronic health record incentive program, also known as meaningful use, will be penalized by Medicare beginning Jan. 1, 2018. To prevent the penalty, physicians must have either attested to meaningful use by March 13, 2017, or applied for a hardship exemption by July 1, 2017.

Why, What, and Who Keys to Recoupment-Proof Documentation - 02/08/2017

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.

HIPAA Audit, Phase 2: Are You in Compliance? - 02/02/2017

The federal government has begun its Phase 2 HIPAA Audit Program. The program aims to assess compliance with a wide array of HIPAA Privacy, Security, and breach notification rules.

Meaningful Use Deadlines Approaching - 01/13/2017

If you're participating in the electronic health record (EHR) incentive program, pay attention to these upcoming attestation deadlines.

Meaningful Use Deadlines Are Approaching - 01/12/2017

If this is your first year to participate in the Medicare meaningful use program and you are trying to avoid the 2017 and 2018 penalties, you must successfully attest to meaningful use no later than Oct. 1, 2016. You can, however, attest by Feb. 28, 2017, to avoid the 2018 penalty. Returning Medicare program participants must successfully attest to meaningful use by Feb. 28, 2017, to avoid the 2018 penalty.

Year-End Checklist for Meaningful Use - 11/30/2016

The Medicare and Medicaid electronic health record incentive programs' 90-day reporting period for 2016 ends on Dec. 31. Now is a good time to review your meaningful use data and the program requirements to make sure you're on track.

Feds Cut Meaningful Use Reporting Period to 90 Days - 11/14/2016

The Centers for Medicare & Medicaid Services (CMS) has reduced the meaningful use electronic health record (EHR) incentive program reporting period from a full year to 90 days in 2016. In 2017, physicians participating in the Merit-based Incentive Payment System (MIPS) will have several reporting options, including reporting on one patient to prevent a penalty, 90 days for a potential incentive, and a full year to receive an incentive. Physicians participating in the Medicaid meaningful use program will continue reporting the meaningful use measures for 2017 and will have a 90-day reporting period.

Check Your Meaningful Use Data - 10/11/2016

Half-way through 2016 is a perfect time to check your meaningful use numbers to make sure you're meeting all of the required measures. Take this opportunity to make any necessary workflow adjustments, or ask for help to ensure you meet the required measure percentages for the numerators and denominators.

CMS Proposes a Break for Docs on Meaningful Use Reporting - 10/11/2016

The Centers for Medicare & Medicaid Services (CMS) proposes easing some of the meaningful use requirements and adjusting the 2016 reporting period from one year to 90 days.

Your Options Following a Recovery Audit Overpayment Determination - 06/03/2016

The Medicare Recovery Audit Contractor (RAC) program is designed to ferret out incorrect payments to physicians, hospitals, and other health care professionals. An appeal to a RAC determination of overpayment is essentially the same as any other Medicare appeal. However, a RAC initial determination is not appealed to the RAC - rather it is appealed to the Medicare carrier, i.e., to TrailBlazer for Texas physicians.

Stay Clear of Medicare Fraud Charges - 06/03/2016

Cracking down on fraud, waste, and abuse in government health care programs has taken a front seat in the U.S. government's drive to control health care costs.

Received a RAC Records Request or Repayment Letter? - 06/03/2016

Texas practices are hearing from Connolly, Inc., the Medicare Recovery Audit Contractor (RAC) for Texas. Be sure to check the validity of any records requests you receive, and weigh your options when responding to a repayment letter.

RAC Auditors Empowered to Perform Complex Reviews - 06/03/2016

Medicare Recovery Audit Contractors now can do complex reviews because limits are set on the number of records they can request (April 2011).

New Toolkit Helps Doctors Navigate Medical Audits - 06/03/2016

The Physicians Advocacy Institute and the American College of Emergency Physicians collaborated to develop the Toolkit for Physicians Facing Medical Audits, which provides practical information and tips to help physicians anticipate medical audits, respond to auditors’ requests for medical records, and appeal erroneous audit findings.

Be Proactive in Preparing for Audits - 06/03/2016

All practices that submit claims to government programs are likely at some point to experience a Medicare Recovery Audit Contractor audit.  If you have not yet prepared for a possible audit, now is the time to get ready and have a plan in place.

Avoid These Six Practices to Stay Clear Medicare Fraud Charges - 06/03/2016

Cracking down on fraud, waste, and abuse in government health care programs has taken a front seat in the U.S. government’s drive to control health care costs. Here are the six top things it is looking for as indications of possible fraud.

New Patient Visit: Three Years Is a Key - 06/03/2016

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.

Coding Myths May Place Physicians at Risk - 06/02/2016

Common coding myths may be a contributing factor to revenue loss and risk of a formal audit in your practice. Here are four common myths.