Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!! Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…
The Auditor’s Role in Appeals: A Key Player in the Compliance Process Written by: Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI The appeals process is a critical component of health care compliance, ensuring that denied claims are appropriately challenged and reconsidered. When providers and health care organizations receive claim denials, they…
Understanding Internal Self-Referrals Written by: Ashley Morgan, Partner, Liles Parker PLLC Healthcare regulations outline legal risks related to internal self-referrals, making it important for both physicians and healthcare organizations to be informed about these issues. While internal referrals may seem like a natural part of integrated healthcare systems, they are heavily regulated under federal and…
Cosmetic Services in Professional Fee Clinics: Compliance Considerations Written by: Jesse Overbay | Associate Director & General Cousel @ DoctorsManagement, LLC Overview of Cosmetic Services in Professional Fee Clinics Across many healthcare settings, including specialized and general clinics, an increasing number of providers are incorporating cosmetic procedures in response to patient interest and evolving treatment…
Incident-to Billing Revisited: Chasing the 15% Written by: Shannon O. DeConda | NAMAS, a division of DoctorsManagement, LLC Incident-to billing, as defined by the Centers for Medicare & Medicaid Services (CMS), has long been both a point of interest and a source of confusion among healthcare providers. For many years, the prevailing advice among compliance…