Healthcare Law

Post-Payment Insurance Audits – Top 10 Areas of Risk

Health insurance payers monitor the billing, coding and documentation practices of health care providers in order to prevent fraud and abuse within the health payment system. A common process that insurers utilize is the post-payment audit or retroactive review of claims. Generally, the insurer will request medical records from the provider and then they will …

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Preparing for an Office Site Visit

The Centers for Medicare and Medicaid Services (CMS), through its contractors, often perform medical record reviews and audits for new and existing providers and suppliers. These audits are conducted to detect potential fraud and abuse within the healthcare payment system. In the past, the records reviews started with a letter from CMS to the provider …

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Healthcare and the Pennsylvania Insurance Fraud Statute

The Pennsylvania Insurance Fraud law makes it a crime when healthcare providers engage in prohibited acts, defined in the law.  Violators are subject to civil penalties and criminal prosecution by the county district attorney or the Attorney General, if the conduct involves more than one county.  If a person is convicted under the Insurance Fraud …

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How Much Does A Healthcare Audit Cost Your Office

By now, most, if not all healthcare providers have been audited by either a health insurance payer or the Centers for Medicare and Medicaid Services, or both. The healthcare audit process can vary depending on the payer; however, most audits follow a general process beginning with a request for medical records. The healthcare provider submits …

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Using Correct CPT Codes To Avoid Healthcare Audits

Healthcare audits are common. Most healthcare providers know someone who has been audited or they themselves have been audited. Audits often reveal issues or concerns with regards to a provider’s billing, coding or documentation. If the payer determines that a problem exists, then the payer will usually request a refund of the overpayment which was …

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Negative Peer Reviews and the PA Act 6 Law

Healthcare providers who provide services and treatment to individuals who are injured in an automobile accident rely on first party medical benefits for reimbursement from the insurance policy covering the individual. Under Pennsylvania’s Motor Vehicle Financial Responsibility Law (MVFRL), automobile liability policies are required to provide a medical benefit in the amount of $5,000.00 or …

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The Medicare Audit: Tips from a Healthcare Attorney

Medicare audits are serious matters. If a healthcare provider receives a notice from a Medicare contractor along with a request for medical records, it is a signal that the provider may not be complying with billing, coding, or documentation guidelines.  An audit determination could cause recoupments of overpayments, ; actions for fraud, including criminal prosecution, …

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Tips for Finding A Good Healthcare Attorney in PA

Healthcare is a unique area of law that requires attorneys to have a tremendous amount of knowledge and experience.  Hospitals, physicians, chiropractors, physical therapists and other healthcare providers often need a lawyer to help them start their healthcare practice, or navigate the insurance and Medicare minefields, or provide an analysis of a particular arrangement under …

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Massage Therapy in a Chiropractic Office in Pennsylvania

In Pennsylvania, massage therapists are now required to be licensed by the State Board of Massage Therapy.  The Massage Therapy Law (63 P.S. §§ 627.1-627.50) and the regulations set forth the guidelines and define the scope of practice for licensed massage therapists (LMT) in Pennsylvania.  The law and the regulations can be found on the …

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The Red Flags Rule Begins on August 1, 2009

The Federal Trade Commission (FTC) will begin its enforcement of the “Red Flags Rule” on August 1, 2009. The Red Flags Rule requires businesses and organizations considered “creditors” under the law to develop, implement and administer a written program to safeguard against identity theft. The FTC has taken the position that health care providers that …

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