In the absence of payer guidance, look to CMS and CPT® for guidance on reporting an E/M as a separate service from chiropractic manipulative treatment with modifier 25. Editor’s Note: Healthcare Business Monthly was recently asked about reporting evaluation and management (E/M) services separately from chiropractic manipulative treatment (CMT) of the spine. As with most ...
In Billing
Sep 28th, 2018
Health Management Associates, LLC (HMA), a hospital chain that has its headquarters in Naples, Florida will be paying over $260 million to avoid criminal and civil claims associated with a scheme to defraud the government of the United States. In this case, the government alleged that HMA was billing inpatient services when they should have ...
In CMS
Sep 11th, 2018
The Centers for Medicare & Medicaid Services (CMS) knows there is a lot of administrative overhead when submitting medical claims for payment. To help you navigate through the red tape, CMS has created a “Administrative Simplification Basics Series,” where you can Sign up for Administrative Simplification email updates. The series helps the healthcare community use electronic ...
In Billing
Sep 10th, 2018
A proposed change to signature requirements in 2019 may effect your practice. The Physician Self-referral Law, or Stark Law,  prohibits physicians to refer Medicare patients for certain designated health services (DHS) to an entity with which the physician (or a member of the physician’s immediate family) has a financial relationship. The DHS entity is held to the ...
In CMS
Aug 13th, 2018
According to a Department of Justice (DOJ) U.S. Attorney’s Office Southern District of New York press release, Mustak Y. Vaid is the latest physician sentenced in a big Medicaid fraud ring involving six Brooklyn clinics between 2007 and 2013, who filled “prescriptions and referrals for medically unnecessary and/or non-existent tests and supplies.” He falsely posed ...