Understanding the Anti-Kickback Statute

Enacted in 1972, the Anti-Kickback Statute protects both patients and federal healthcare programs from abuse, including fraud. The statute was a part of the Social Security Amendments of 1972, which were followed closely by the 1977 Medicare and Medicaid Anti-Fraud and Abuse Amendments. Fraud was no longer considered a misdemeanor but rather a felony with…


Top 5 Risks of ICD-10 Conversion

ICD-10 conversion seems daunting in sheer numbers. With over 50,000 diagnosis codes, the possibility for error looms larger than ever. And that could mean substantial fines come the October 2015 deadline. The good news is that the general risk is smaller for smaller medical practices. After all, a smaller practice often gives more specific care…


How The False Claims Act Affects Your Clinic

A review of the False Claims Act is beneficial even to those who have been in the healthcare industry for decades, along with those who are new to the system. The FCA was originally enacted in 1863 to address military fraud against the Union Army. And while the False Claims Act reaches beyond those in…


Health Insurance Benefits Will Now Be More Easily Compared

On December 22, 2014 the Departments of Health and Human Services, Labor, and the Treasury announced a proposal of a new rule that would streamline the health insurance benefits offered on health exchanges and through employers. This rule would require a standardized summary outlining which health insurance benefits are covered by a particular plan and…


PQRS 2015 – Changes to Consider

PQRS, or the Physician Quality Reporting System, is a program implemented for reporting purposes under Medicare Part B. This voluntary program provides incentives to practices who employ eligible professionals (EPs), as identified by an NPI (National Provider Identifier) and TIN (Tax Identification Number). By reporting data on services to Medicare Part B Fee-for-Service beneficiaries, EPs…


Congress Pushes Back ICD-10 Implementation Date

On Monday, March 31, the United States Senate approved a bill that pushes back the ICD-10 implementation date. The original roll out, scheduled for October 2014, was pushed back in conjunction with steep cuts to Medicare physician payment rates. The Protecting Access to Medicare Act of 2014 postponed a planned 24% cut to physician pay…