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Medicare Audits

July 10, 2014 0 Comments
Medicare Audits

Have you had a Medicare audit?  Medicare has a number of program integrity contractors that can pry into your records, while you are sleeping, as well as during the day for an onsite “surprise ” visit.   Most likely if you have had a Medicare audit, it was most likely a medical review of a claim […]

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Therapy Groups

July 9, 2014 1 Comment
Therapy Groups

The question of therapy groups always seems to come up for therapy providers after a staff member has attended a CEU course, or perhaps sought out advice via an online message board or list serve.  Invariably the information is not accurate. It’s happened again!  Let me call it the rogue weekend CEU course as the […]

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OIG Upcoming Changes

July 4, 2014 0 Comments
OIG Upcoming Changes

OIG Tips Series ~ OIG upcoming changes in CMP and Exclusions were highlighted by Inspector General Dan Levinson at HCCA’s Compliance Institute this past spring.  In continuing his use of colorful slides from the San Diego area the owl was used as a signal to compliance office to be on the outlook for upcoming changes.  Levinson pointed to three upcoming initiatives at […]

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Jimmo Maintenance Accountability

July 3, 2014 0 Comments
Jimmo Maintenance Accountability

Medicare Maintenance Series ~ The JIMMO Settlement clarified that skilled maintenance therapies (and nursing) are covered by Medicare. As we enter the Jimmo maintenance accountability phase it is good to review the basics of this important legal case.  As a result of the Settlement Agreement CMS was required to revise pertinent sections of the Medicare […]

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Compliance Adaptability

July 2, 2014 0 Comments
Compliance Adaptability

OIG Tips Series ~ Compliance adaptability is one of the tips given by Inspector General Dan Levinson by Inspector General Dan Levinson at HCCA’s Compliance Institute this past spring.  In continuing his use of colorful slides from the San Diego area the urban crow was front and center.  According to Levinson: ….the urban crow is a great adaptive creature. It actually will figure […]

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OIG Compliance Tips

July 1, 2014 0 Comments
OIG Compliance Tips

OIG Tips Series ~ Do you have an off the shelf, or out of the box compliance plan?  OIG compliance tips given by Inspector General Dan Levinson at the annual HCCA Compliance Institute are always valued by the compliance officers and professionals in attendance at the keynote speech.  This spring at the Compliance Institute in San […]

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Strategic Health Solutions Reports CMS Therapy Audit Results

May 13, 2014 4 Comments
Strategic Health Solutions Reports CMS Therapy Audit Results

Strategic Health Solutions just posted CMS Therapy Audit Results of one of their outpatient therapy audits.  Strategic conducted two audits involving outpatient therapy last summer.  The first audit topic was related to therapy stoppage at the end of the year 2012  (or at the cap), and then resumed in the new year (2013).  The second […]

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Tricare and Private Practice PTAs

March 18, 2014 14 Comments
Tricare and Private Practice PTAs

Tricare policy does not allow for therapy to be paid when it is provided by a physical therapist assistant (PTA) in private practice settings.  A previous post on this generated a lot of comments , as well as a lot of email.  The reference in that post on Tricare and private practice PTAs was the […]

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Medicaid Exclusion Checks

March 17, 2014 2 Comments
Medicaid Exclusion Checks

CMS issued a State Medicaid Director Letter (SMDL)  in 2009 recommending that States require providers to screen all employees and contractors monthly.  However in 2011, CMS issued final regulations mandating States to screen all enrolled providers monthly.   Furthermore Section 6501 of PPACA requires States to terminate individuals or entities from their Medicaid programs if the individuals […]

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Importance of Checking Exclusions

March 16, 2014 2 Comments
Importance of Checking Exclusions

Checking exclusions is a key component of any viable compliance program.  The Office of the Inspector General (OIG) of the US Department of Health and Human Services maintains a list of excluded individuals and entities (LEIE).   Anyone who hires an individual or entity named on the LEIE may be subject to civil monetary penalties (CMP).  […]

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