Medicare Compliance & Reimbursement

Look for these legit reasons to explain an outlier practice pattern. Government agencies and auditors are on a roll in pursuing what they view to be inappropriate healthcare utilization. And that means physicians and physician practice groups might be wise to give their practice patterns a check-up. Physicians should understand how their practices "relate to the prevailing standard of care in their geographic location and nationally," advises attorney Jason Caron, with Epstein, Becker & Green in Washington, D.C. Making that effort isn't important just for the sake of federal compliance, he adds. It "relates to a host of other issues, including potential reputational and malpractice issues." Using this approach, "the organization can make informed decisions" about how they stack up "relative to their peers and can ... either adjust or curtail certain practices or support their legitimate clinical reasoning  behind practice patterns that may fall outside the norm," says Caron. 3 [...]