tag:blogger.com,1999:blog-4098366697978462872024-03-07T23:19:12.469-08:00Practical Solutions for the Private PracticeChris Burnshttp://www.blogger.com/profile/13364815640510384474noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-409836669797846287.post-34802775666272519942010-12-23T09:20:00.000-08:002010-12-23T14:53:20.122-08:00Physician Audit Vulnerabilities Detailed in Medicare Article<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">Continuing its efforts to publicize valuable information derived from the RAC demonstration project, CMS released on December 2nd the fourth in a series of MLN Matters articles.<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The latest, Special Edition article SE1036, provides education on two high-risk vulnerabilities for physician claims. According to CMS, claims were denied because the demonstration RACs determined that either <b>a duplicate claim was billed and paid, or the physician reported an incorrect number of units</b> for CPT codes billed based on the CPT code descriptor, reporting instructions in the CPT book, and/or other CMS local or national policy.<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">These RAC findings highlight the importance of the accuracy of the CPT code descriptions used in physician's charge documents (superbills), and should also discourage physicians from submitting charges repeatedly "just to be sure they weren't missed the first time."<br />
</span></div><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;"><a href="http://www.cms.gov/MLNMattersArticles/downloads/SE1036.pdf">Click here</a> to read the entire MLN article.</span></div><div id="short_content" style="font-family: Verdana,sans-serif;"><span style="font-family: Verdana,sans-serif;"> </span></div>Chris Burnshttp://www.blogger.com/profile/13364815640510384474noreply@blogger.com0tag:blogger.com,1999:blog-409836669797846287.post-36118389444676209132010-08-19T14:41:00.000-07:002010-12-23T10:23:47.498-08:00United Healthcare Class Action Lawsuit<div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">By now most physicians are aware of the class action lawsuit brought against UHC and its subsidiaries by the AMA and other plaintiffs. The lawsuit alleges that UHC provided insufficient reimbursement for covered <b><i><span style="color: purple;">out of network</span></i></b> (OON) services by:</span></div><ul style="font-family: "Trebuchet MS",sans-serif;"><li><span style="font-size: small;">using flawed databases developed by Ingenix in determining reimbursement amounts for covered OON health benefits;</span></li>
<li><span style="font-size: small;">using the OON reimbursement policies to reduce reimbursement amounts improperly for covered OON health benefits; and</span></li>
<li><span style="font-size: small;">inadequately disclosing the use of the Ingenix databases and their OON reimbursement policies in determining reimbursement amounts for covered OON health benefits.</span></li>
</ul><div style="font-family: "Trebuchet MS",sans-serif;"><span style="font-size: small;">The most important thing to understand about this lawsuit is that it applies only to <span style="color: purple;"><b><i>non-contracted providers</i></b></span>, as only they could have provided <b><i><span style="background-color: white; color: purple;">out of network</span></i></b> (OON) services. Since the vast majority of PDS clients are <u>contracted</u> providers with UHC, this class action settlement does not apply to you. For more information on this and other payer-related class action lawsuits, <a href="http://www.hmosettlements.com/">click here</a>.</span></div>Chris Burnshttp://www.blogger.com/profile/13364815640510384474noreply@blogger.com0tag:blogger.com,1999:blog-409836669797846287.post-15883284950253392892010-08-18T16:39:00.000-07:002010-12-23T10:25:51.551-08:00McKesson EHR Webinar Highlights<span style="font-family: "Trebuchet MS",sans-serif; font-size: small;">McKesson hosted a comprehensive 1-hour webinar covering the final ruling on "meaningful use" and the funding available to physicians who implement a qualified EHR in their practice. Contact PDS or <a href="http://www.mckesson.com/doctors">click here</a> for a copy of the presentation.</span>Chris Burnshttp://www.blogger.com/profile/13364815640510384474noreply@blogger.com0