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Texas Dep’t of Insurance Workers Comp Division Releases 2009 Report Card

The Texas Dep’t of Insurance Dep’t of Workers Compensation has recently released the results of its 2009 Performance-Based Oversight Assessment. The results of the assessment could impact your practice. Assessments were conducted on the performance of two key players in the worker’s compensation arena:  insurance carriers and healthcare providers. Insurance carrier report card Insurers were […]

Falls Prevention Awareness Day and Physical Therapy Assessments

As the nation observes Falls Prevention Awareness Day on September 22, the American Physical Therapy Association (APTA) is urging older adults to schedule a balance and falls assessment with a physical therapist to reduce risk of falls and related injuries. Does your practice offer falls risk assessments? Are your referring Dr’s aware that you offer […]

Texas Worker’s Compensation and Preauthorization Rules

There seems to be confusion among healthcare providers and their staff regarding which services must be preauthorized under Texas Worker’s Compensation rules, what is required of the provider, and what are the obligations of the carrier. A number of treatments and services do require preauthorization, below are just a few: Inpatient hospital admissions Surgical procedures […]

Medicare Feedback—Chiropractic Documentation Errors

I often receive calls and emails pertaining to chiropractic services and mysterious Medicare denials and requests for documentation.  There can be a number of reasons for both.  I will be releasing more articles on specific billing issues that are common to chiropractic services, but today we will focus on documentation errors due to the timeliness […]

Legible Documentation Signatures—Not Optional

A recent alert went out from various Medicare contractors concerning the requirement for  healthcare providers to include a legible signature on their documentation. It turns out that in some cases, providers are not signing their documentation at all! Audits conducted by the Office of the Inspector General (OIG) and CERT (Comprehensive Error Rate Testing) have […]

Billing Medicare for Non-Covered Services

Yesterday we discussed the practice of billing non-covered services under a payable code, and clearly established that such a practice would be considered fraudulent. This does not mean that the provider does not deserve to be paid for the service nor does it mean that he must automatically write the charges off as a loss. […]

Billing a Non-covered Service under a Payable Code

Can we do that? I could not begin to recount all the times I have heard healthcare providers or their staff ask if they can bill Medicare or another insurance carrier for a non-covered service that they perform, but just code it as something else so that they can get paid. It is little wonder […]

Avoid Unnecessary Denials! Use your Medicare Local Coverage Determinations!

What is a “Local Coverage Determination” (LCD)?                                                                                          Medicare contracts with private companies like Palmetto, Noridian, Novitas, etc. to administrate—process and pay claims in a specific region. Medicare Carriers and Fiscal Intermediaries (FIs) are private companies that Medicare contracts with to pay bills. More recently some FI’s have been replaced with the MAC […]

Out of Pockets and Deductibles

Please Explain Out of Pockets and Deductibles As in yesterday’s topic, many clinic staff members seem to think that these two terms mean one in the same thing.  The results can be less than desirable if the difference between out of pockets and deductibles is not clearly understood. In a nutshell: Out of Pocket (OOP) […]