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Medical Billing Codes

ArentFox Schiff

Investigations Newsletter: Medical Device Manufacturer THD Pays $700,000 to Resolve FCA Allegations

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Medical Device Manufacturer THD Pays $700,000 to Resolve FCA Allegations - On September 6, the US Attorney’s Office for the District of Maryland announced that THD America, Inc., and its parent company, THD SpA of Italy,...more

Husch Blackwell LLP

DOJ False Claims Act Suit Against Montana Oncologist Is a Warning Sign to Busy Physicians

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On August 26, 2024, the United States Attorney’s Office for the District of Montana filed a False Claims Act (FCA) complaint against a Montana oncologist, alleging that the oncologist’s busy schedule led to excessive claims...more

Bass, Berry & Sims PLC

CMS Solicits Comments to Clarify Parameters on MAC Downcoding of Complex Drug Administration Infusion Services

In the proposed CY 2025 Physician Fee Schedule (PFS) published in the Federal Register on July 31, the Centers for Medicare & Medicaid Services (CMS) is soliciting comments on a proposal to revise the Medicare Claims...more

Marshall Dennehey

Delaware Supreme Court Affirms the Decisions of the IAB and Superior Court, Holding That an Employer Correctly Paid for Ketamine...

Marshall Dennehey on

Taylor v. State of Delaware, 2024 WL 1209292 (Del. Super. Mar. 21, 2024) - Ms. Taylor injured her right wrist in 2016 while working as a teacher for the State. Her injury eventually developed into complex regional pain...more

McDermott+

The Budget Neutrality Paradox: Explaining the CY 2025 PFS Positive Budget Neutrality Adjustment

McDermott+ on

The major calendar year proposed regs are now out, with thousands of pages of text to digest. Since a plethora of issues are embedded in these regs, including the Calendar Year (CY) 2025 Physician Fee Schedule (PFS) and the...more

Mintz

Massachusetts Attorney General’s Office Indicting Dental Providers for Fraud and Patient Harm. Behavioral Health Providers Are on...

Mintz on

True to their word in several recent public statements, the Chief and Deputy Chief of the Medicaid Fraud Division of the Massachusetts Attorney General's Office have brought several recent criminal cases against dentists for...more

Health Care Compliance Association (HCCA)

Compliance with Medicare’s updated 2024 split (or shared) visit policy

Split (or shared) visits—the current term used by the Center for Medicare & Medicaid Services (CMS)—allow non-physician practitioners (NPPs) and physicians who work for the same employer/entity to share patient visits on the...more

Harris Beach PLLC

HHS OIG Work Plan – December Update – Audits for Medicare Emergency Codes

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In its December 18, 2023, Enforcement listserv notice, HHS’s Office of Inspector General (“OIG”) published its Work Plan Updates for December. Although six updates were published, this article will only highlight the...more

McDermott Will & Emery

Stark Law Changes for 2024: CMS Updates Designated Health Services Code List

McDermott Will & Emery on

On November 29, 2023, the Centers for Medicare & Medicaid Services (CMS) published the 2024 annual update to the designated health services (DHS) Code List. This annual update includes important changes for Medicare providers...more

Health Care Compliance Association (HCCA)

[Event] 28th Annual Compliance Institute - April 14th - 17th, Nashville, TN

Get ready to be inspired with game-changing insights and industry connections! For over two and a half decades, healthcare compliance professionals have gathered at HCCA’s Compliance Institute (CI) to share ideas, learn...more

McDermott Will & Emery

Remote Monitoring and Digital Therapies: CMS Updates Coverage and Payment Policies

McDermott Will & Emery on

In recent years, the Centers for Medicare & Medicaid Services (CMS) has expanded payment for remote monitoring services in an effort to pay for non-face-to-face services that improve care coordination for Medicare...more

Foley & Lardner LLP

Top 5 Rules for Medicare 2024 Remote Patient Monitoring and Remote Therapeutic Monitoring: What Companies Need to Know

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On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized new policies related to remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) services reimbursed under the Medicare...more

King & Spalding

CMS Proposes 200% Fee Hike to No Surprises Act IDR Fees

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On September 20, 2023, the Departments of Health and Human Services, Labor, and the Treasury (the Departments) announced the Federal Independent Dispute Resolution (IDR) Process Administrative Fee and Certified IDR Entity Fee...more

Jackson Walker

September Signals Start of College Football Season and Texas Medical Debt Billing Reforms Under S.B. 490

Jackson Walker on

Physicians, hospitals, and healthcare providers: have you updated your billing practices? As of September, any individual or facility licensed or certified to provide healthcare services in Texas must provide an itemized...more

Cozen O'Connor

The State AG Report – 8.24.2023

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Here are curated AG and federal regulatory news stories highlighting key areas in which state and federal regulators’ decisions are having an impact across the US: •Montana AG Mounts Defense of State’s TikTok Ban- •DC AG...more

Husch Blackwell LLP

Physician Loses Rare Criminal E/M Fraud Trial

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Evaluation and management (E/M) services have been called “the core” of healthcare billing. E/M is a catch-all claim, allowing medical professionals to bill for diagnosing or treating nearly any illness or injury. E/M is also...more

Kohrman Jackson & Krantz LLP

Coverage Challenges in Ransomware Claims: Cyber Insurance Policies and Trends in Denials

A consistent pattern emerges in data breach and cyber-attack cases when companies turn to their insurers for coverage after such incidents. Whether they possess specialized cyber insurance or not, insurers often decline...more

The Volkov Law Group

The Unique Elements of Healthcare Compliance Programs (Part II of II)

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Corporate compliance programs in the healthcare industry include many of the same elements that we are all familiar with – risk assessments, code of ethics, written policies and procedures, comprehensive training...more

Husch Blackwell LLP

Heed Caution: Takeaways From the OIG's Advance Care Planning Report

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The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reported in November 2022 that many providers are not complying with Medicare’s billing rules for advance care planning services. In large...more

Bass, Berry & Sims PLC

Recap of Webinar: Billing, Coding, and Collecting for Infusion Services

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Bass, Berry & Sims attorney Shannon Wiley, with Carine Leslie and Katie Garmon of PYA, P.C., recently discussed the complexities associated with billing, coding, and collecting for infusion services as part of the Infusion...more

ArentFox Schiff

Erroneous Schizophrenia Coding Will Decrease Nursing Home Star Ratings and New Information To Be Included In Nursing Home Care...

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On January 18, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a Memorandum to all state survey agency directors addressing erroneous schizophrenia coding and increased transparency of Nursing Home Care...more

Reveal

Health Information Management: How It Helps Prevent PII and PHI Breaches

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Healthcare organizations collect and generate tremendous volumes of highly sensitive—and highly regulated—information about patients every day. A substantial portion of this data is personally identifiable information (PII)...more

Husch Blackwell LLP

Surprise! What Hospices Need to Know About the No Surprises Act

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While direct patient billing may be less common for hospice patients than for patients receiving hospital or other types of care, there are aspects of the No Surprises Act and its implementing regulations that are important...more

Foley & Lardner LLP

Migraine Company Fails to Avoid Own Headache: Jet Medical and Others to Pay $745,000 to Resolve Allegations that Medical Device...

Foley & Lardner LLP on

On January 4, 2023, the Department of Justice issued a press release stating that Jet Medical Inc. has agreed to pay $200,000 to resolve criminal allegations relating to a migraine headache treatment. Jet Medical and two...more

ArentFox Schiff

Investigations Newsletter: Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations

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Medical Device Company to Pay Over $700,000 To Resolve Criminal Allegations - On January 4, 2023, a criminal information was filed in the Southern District of Illinois, in which Jet Medical Inc. (Jet), a medical device...more

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