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2013 Brings Many Changes for Therapists in the Medicare Program

 Hold onto those party hats….ringing in the New Year should definitely set off some bells and whistles for therapy providers who treat Medicare patients.   There are 2 big changes coming that are definite and one very real possibility: PQRS (Medicare Physician Quality Reporting System) Therapists who bill Medicare for outpatient therapy services in private practice […]

Is Your Fee Schedule Defensible?

    As a healthcare provider, are you able to defend your fee schedule to both patients and insurance carriers? A 2009 settlement in a lawsuit filed by New York’s Attorney General against United Health Group has resulted in the formation of an independent nonprofit entity named FAIR HealthTM.   FAIR Health was called upon to […]

Texas Department of Insurance Imposes Fines on Payers, Doctors, Clinics

The Texas Department of Insurance, Workers’ Compensation Division (TDI-DWC) has just released a list of payers, clinics, and doctors for whom disciplinary measures have been imposed due to violations of the Texas Labor Code and DWC rules. A brief review of the Enforcement Actions posted for 2011 reveals that roughly half of the entities who […]

Alert: Big Changes Coming for Medicare Therapy/Rehab Providers

Changes Ahead for Therapy Providers The 2011 Medicare Physician Fee Schedule Final Rule has been released—all 2023 pages of it.  How does the final rule affect physical therapy and rehab providers?  Here is the breakdown: Therapy caps: 2011 outpatient therapy cap will be $1870 (page 382) The exceptions process to the therapy caps will expire on December […]

November is Heal that Claim Month

Do you wish you and your staff had more time and resources to focus on caring for your patients?  November is the third annual “Heal that Claim”TM month, and physician practices are being urged to take a stand against flawed and inefficient claims processing. One in five medical claims is processed inaccurately by commercial health […]

Would Your Documentation Stand Up to a Medicare Audit?

Documentation under the Magnifying Glass Facts & findings from recent Medicare audits reveal 3 main areas where payment errors were identified.  The  results?  Charges denied as “Insufficient Documentation” ….leading to recoupment. The 3 most common deficiencies were: Illegible or missing signatures on documentation or orders Signature requirements are nothing new–but CMS and its audit contractors […]

Virginia College Healthcare Reimbursement Services Opens Shop in Austin

A new business affiliated with Virginia College in Austin, Texas, recently opened its doors in the Capitol City, with the aim of assisting medical practices in their billing and medical coding needs.  Virginia College Healthcare Reimbursement Services (HRS) is a billing service owned and operated by the school, and is managed and staffed by certified […]

PECOS: Are You Enrolled? Are Your Referring Dr’s?

Are your providers currently enrolled in the Medicare PECOS system?  Are the providers who regularly refer patients to your clinic enrolled? PECOS:  Provider Enrollment, Chain and Ownership System Many providers are still unaware of the PECOS system, the need for enrollment, and the negative impact that failure to enroll could have on their practice. Although […]

Chiropractors Under the Magnifying Glass of Medicare

Is your practice prepared? Multiple audits performed by TrailBlazer, the Office of the Inspector General and most recently the Comprehensive Error Rate Testing (CERT) contractor have revealed unacceptably high numbers of inappropriately paid claims for chiropractic manipulation. Findings echoed previous results of government auditors. As a result, Chiropractors can continue to expect their claims to […]