Nov 10th, 2017
Lately it seems that the Office of Inspector General’s (OIG) focus is on fraud and abuse of federal healthcare dollars via the False Claims Act; however, a case in Newark, N.J., has proven that the Anti-Kickback Statute also is being enforced in a big way. A Staten Island doctor, Ahmed El Soury, has been sentenced ...
Any provider who receives referrals from other medical professionals must pay close attention to, and should do their best to nurture, these relationships. Most referrals originate in a primary care physicians office (family practice, pediatrician, internal medicine), but there are also referrals from specialist to specialist. Here are some tips to strengthen your referral patterns. ...
In Coding
Sep 18th, 2012
It is possible that within a few years, if your providers are challenged with a difficult or unusual case, an email to a major clinic such as the Mayo or Cleveland will help resolve the patient’s woes. Facilities and medical groups affiliated with these centers are already reaping benefits. An article in The Atlantic Monthly ...
In CMS
May 11th, 2012
Provider Enrollment, Chain and Ownership System (PECOS) rules finalized by the Centers for Medicare & Medicaid Services (CMS) will make it easier for physicians to refer patients to specialists. PECOS: Medicare Referral Rules Change was last modified: May 15th, 2012 by admin aapc...
In CMS
Oct 19th, 2009
Physicians, non-physician practioners (NPPs), and other Part B providers and suppliers submitting claims to carriers or Part B Medicare Administrative Contractors (B/MACs) for ordered or referred items or services can expect further scrutiny during the claims editing process. Beginning Oct. 5, carriers and B/MACs expanded claims editing to include validation of the ordering/referring provider’s nat...