The United States Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS) recently announced a change to the appeals process. The changes will impact Medicare beneficiaries, providers and suppliers.
As you know, aches and pains come with the territory as you age, but it does not mean your clients have to take it lying down. They have every right to continue living an active and passionate life as pain-free as possible, which often means regularly seeing their chiropractors. As you and many other Texans are aware, good chiropractic care can make the difference between suffering through chronic back and extremity pain and feeling on top of the world.
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 mandates removal of Social Security Number (SSN)-based HIC numbers from Medicare cards to address current risk of beneficiary medical identity theft. CMS will use a new MBI generator to assign over 150 Million MBIs beginning April 1, 2018, and continuing through December 31, 2019, for full implementation January 1, 2020. While CMS will continue to process transactions utilizing a beneficiary's current HIC number during the transition period, Medicare fee for service entities must modify their current processes and systems to be ready to submit or exchange the MBI by April 1, 2018. The current system requires a 9-byte SSN plus 1 or 2-byte BIC. The MBI system will require an 11-byte alpha numeric numeration system. All Medicare fee for services entities are advised to check all of their internal billing systems to be certain the software they are currently using will accommodate the new MBIs. During the transition period, Medicare entities will be allowed to enter either the MBI or HIC number. If you use vendors to bill Medicare, ask them about their MBI practice management system changes and make sure they are ready for the change.
United Therapeutics Corporation (UT), based in Maryland, has just agreed to settle Anti-Kickback Statute and False Claims Act allegations for $210 million. The drug maker has also entered into a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.
If you receive a letter from the Health Integrity or Office of Inspector General in Texas regarding the overpayment of Medicare claims from your practice, you may wonder what you can do to avoid penalties. Even though you may feel embarrassed, confused or worried about the situation, it is important you make your specific circumstances top priority.
Health care fraud is a growing concern for many medical and health care providers in Texas. Some providers seek to profit off unlawful activities to increase their profits. However, many health care providers are honest and under heavy scrutiny and sanctions because of the wrongful actions of others. Some potential causes of health care fraud are the result of mistakes in the billing process. Many of those errors are avoidable with the right processes and checks and balances in place.
In mid-January, the Centers for Medicare & Medicaid Services published a home health agency final rule outlining new minimum standards for home health agencies participating in Medicare and Medicaid.
Another doctor has been convicted for playing a part in a multi-million-dollar Medicare fraud scheme. The guilty verdict shows that even being "extremely naïve" is not a valid defense to Medicaid fraud charges.
Coding and billing fraud are once again major targets for the Office of the Inspector General (OIG) and the Department of Justice.
In recent years, federal authorities have been making an effort to prevent fraud, waste and abuse within the Medicare and Medicaid programs. As a result, health care businesses of all types and sizes are being accused of overpayments.