News & Analysis as of

Medical Billing Codes

Bradley Arant Boult Cummings LLP

Medicare Advantage Programs’ Increasing Popularity Invites Heightened FCA and Regulatory Scrutiny

As Medicare Advantage attracts more eligible beneficiaries, it is also drawing attention from False Claims Act (FCA) prosecutors. In 2022, enrollment in Medicare Advantage plans reached 28.7 million Medicare beneficiaries, or...more

Bass, Berry & Sims PLC

SDNY Ruling in Anthem Sends a Signal to Medicare Advantage Litigants

Bass, Berry & Sims PLC on

In a decision issued on September 30, Judge Andrew Carter of the U.S. District Court for the Southern District of New York denied Anthem Inc.’s motion to dismiss a government lawsuit filed in March 2020 claiming Anthem...more

Bass, Berry & Sims PLC

Medicare Advantage Plan Highlights Distinction for FCA Purposes between Clinically Inaccurate Diagnoses and Clinically Accurate...

Bass, Berry & Sims PLC on

In a September 2022 filing in U.S. ex rel. Osinek v. Kaiser Permanente, the Kaiser Permanente consortium defendants (Kaiser) highlighted the distinction between clinically inaccurate diagnoses (factual falsity) and clinically...more

Harris Beach PLLC

Inspector General Issues Report on Telehealth Services During Pandemic

Harris Beach PLLC on

Recently, the Office of Inspector General (“OIG”) for the Department of Health and Human Services published its Report on Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks...more

King & Spalding

OIG Publishes Report on Program Integrity Risks Related to Medicare Telehealth Services During the First Year of the Pandemic

King & Spalding on

On September 2, 2022, OIG published a report of its findings summarizing its investigation into whether providers appropriately billed for Medicare beneficiaries’ telehealth services. This report analyzed data from the...more

Health Care Compliance Association (HCCA)

Physician coding and billing risks

CT magazine (August 2022) - Medical school curriculum is heavy in anatomy, physiology, biochemistry, pathology, and clinical rotations or clerkships. There is very little, if any, instruction on proper coding and billing...more

Foley & Lardner LLP

Remote Therapeutic Monitoring: What You Need to Know About CMS’ Proposed Changes

Foley & Lardner LLP on

On July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed five new changes to Remote Therapeutic Monitoring (RTM) services under the Medicare program. The changes, part of the proposed 2023 Medicare...more

Waller Lansden Dortch & Davis, LLP

Hospital Price Transparency Final Rule Sparks Fines for Noncompliance

The Centers for Medicare and Medicaid Services (CMS) imposed its first fines as of June 7, 2022, totaling over $1 million, on two Georgia hospitals within the Northside Hospital System for failing to comply with CMS’ Hospital...more

Oberheiden P.C.

Medicare TPE Audits: 6 Things You Need to Know

Oberheiden P.C. on

Targeted Probe and Educate (TPE) audits have recently become a common tool used by both law enforcement and private insurers in the Medicare program. While they focus on educating Medicare providers about proper billing...more

Mintz - Health Care Viewpoints

DOJ Announces Another Wide-Ranging COVID-19 Fraud Enforcement Action

For the last few years, we have been closely monitoring and reporting on COVID-19 related fraud enforcement efforts by federal agencies. We detailed those findings in our Health Care Enforcement 2020 Year in Review & 2021...more

Foley & Lardner LLP

Deadline Approaching Under Health Plan Price Transparency Rules – Public Disclosure of Provider Reimbursement Rates Due by July 1,...

Foley & Lardner LLP on

Enforcement of one of the Transparency in Coverage Final Rules (“TiC Rules”) begins on July 1, 2022. The rule requires plans and issuers to make machine-readable files publicly available that will disclose in-network rates...more

Sheppard Mullin Richter & Hampton LLP

Tax Break for Certain Medical Billing Services in Texas

Texas HB 1445, which went into effect on January 1, 2022, exempts medical billing services performed before the submission of the relevant insurance claim from state sales tax. The new legislation legally exempts medical...more

Oberheiden P.C.

5 Tips for Lab Compliance in 2023

Oberheiden P.C. on

In many ways, the COVID-19 pandemic increased the business opportunities available to clinical labs, including molecular and respiratory labs. As the nation—and the world—struggled to develop adequate testing infrastructure,...more

Foley & Lardner LLP

Continuing Consolidation in Orthopedic Medicine

Foley & Lardner LLP on

Physician consolidation continued on a robust pace this past year, despite, or maybe because of, the Pandemic. Physician-owned orthopedic practices appear to be no exception to this trend. Interestingly, orthopedic...more

Rivkin Radler LLP

[Webinar] Lunch-and-Learn Series: Recent Developments in Telehealth: For the Pandemic and Beyond - November 18th, 12:00 pm - 1:00...

Rivkin Radler LLP on

Please join us as Rivkin Radler Partner Eric D. Fader provides an overview of changes in the provision of telehealth services and federal and state regulation of them, since the beginning of the COVID-19 pandemic. New rules...more

Nelson Mullins Riley & Scarborough LLP

Increased Enforcement Activity Expected Relating to Healthcare Provider Billing Upcoding

A pair of recent reports issued by the Health and Human Services Office of Inspector General (“OIG”) and Cotiviti, a Centers for Medicare and Medicaid Services (“CMS”) Recovery Audit Contractor (“RAC”), indicate a resumed...more

Health Care Compliance Association (HCCA)

[Virtual Event] Clinical Practice Compliance Conference - October 12th - 13th, 8:50 am - 6:00 pm CDT

Get the latest updates on government initiatives related to physicians and clinics - HCCA’s Clinical Practice Compliance Conference provides insights, updates, and strategies that are pertinent to developing and managing...more

Faegre Drinker Biddle & Reath LLP

Part One of Surprise Medical Billing Regulatory Guidance Outlines Specific Required Changes to Group Health Plan Payment...

The No Surprises Act (the “NSA”), which was signed into law at the end of 2020 as part of the Consolidated Appropriations Act, is designed to protect consumers from unexpected medical bills. The NSA generally applies to...more

Foley & Lardner LLP

Medicare Proposes New Changes for Telehealth Services in 2022

Foley & Lardner LLP on

...On July 13, 2021, the Centers for Medicare and Medicaid Services (CMS) released an advance copy of the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) proposed payment rule, to be published on July 23, 2021....more

Foley & Lardner LLP

CMS to Permanently Cover Audio-Only Telemedicine for Mental Health

Foley & Lardner LLP on

...The Centers for Medicare & Medicaid Services (CMS) has proposed permanent Medicare coverage of audio-only mental health telehealth services. Currently, Medicare covers audio-only telehealth under temporary waivers that...more

Foley & Lardner LLP

CMS Proposes New Remote Therapeutic Monitoring Codes: What You Need to Know

Foley & Lardner LLP on

The Centers for Medicare & Medicaid Services (CMS) has proposed a new category of digital health services—Remote Therapeutic Monitoring (RTM)—to complement the existing suite of Remote Physiological Monitoring (RPM) codes...more

McDermott Will & Emery

[Webinar] 340B… Or Not 340B: Oversight, Compliance and Enforcement - July 15th, 9:00 am - 10:00 am PT

McDermott Will & Emery on

The 340B Program has gained national attention over the last decade, in part due to the opportunities it provides to generate revenue for participating entities without risk of significant enforcement penalties for...more

King & Spalding

Line Item Disallowances And Coding Denials

King & Spalding on

Health plans are using both new and old methods to deny healthcare providers’ claims, all of which are legally and factually unsupportable. These tactics have repeatedly been rejected by arbitrators in scores of arbitrations,...more

King & Spalding

California Court of Appeal Decision Highlights Importance of Technical Details in Billing Practices and Managed Care Agreements

King & Spalding on

Hospitals and other health care providers work hard to eliminate billing and coding errors, but mistakes still happen. When those mistakes occur, health plans sometimes try to capitalize on the error by using it as a basis to...more

Health Care Compliance Association (HCCA)

Radiation Therapy Provider Pays $3.6M in CMP Settlement; OIG: 25 CPT Codes ‘Involved’

Report on Medicare Compliance 30, no. 22 (June 14, 2021) - A Colorado radiation therapy provider has agreed to pay $3.569 million in a civil monetary penalty settlement with the HHS Office of Inspector General (OIG). ...more

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Privacy Officer
JD Supra, LLC
150 Harbor Drive, #2760
Sausalito, CA 94965

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Privacy Officer
JD Supra, LLC
150 Harbor Drive, #2760
Sausalito, CA 94965

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