Wednesday, November 21, 2012

An Effective Compliance Program: Preventive Medicine for the
Individual and Small Physician Group Practice


With federal and state fraud and abuse enforcement efforts on the rise, all health care providers must be vigilant in identifying areas of risk and putting in place mechanisms to ensure regulatory compliance.  This holds true not just for larger institutional providers, but for individual and small physician group practices as well.  With the proliferation of federal and state contractors tasked with performing audits of coding and  billing practices, physician practices must be prepared to demonstrate proper coding and billing practices and proper documentation to support those practices.  The best preventive medicine for the individual and small physician group practice is a carefully drafted compliance program to identify and address areas of risk and to promote a culture of compliance within the practice.

Monday, November 12, 2012

Reforming Medicare Audits


On October 16, 2012, the Medicare Audit Improvement Act of 2012[1] was introduced in the U.S. House of Representatives by Representative Sam Graves. The purpose of this legislation is to reform the Medicare auditing program. This legislation aims to improve the accuracy and transparency of Medicare audits of hospitals as well as increase the accountability of Recovery Audit Contractors (“RAC”).[2]

RACs have a financial incentive to be overzealous and find unnecessary billing errors, because they are paid contingency fees based upon the amount of money they recover.[3] As a result, the RAC process has resulted in burdensome document requests, unjust recoupments, and inappropriate denials, many of which have been overturned upon appeal.


Tuesday, November 6, 2012

The Kentucky Health Benefit Exchange:
Little Gnome Facts

"Like Travelocity but for health insurance” is how Executive Director Carrie Banahan and Deputy Director Bill Nold of the Office of Kentucky Health Benefit Exchange describe the developing Kentucky Exchange.

Historically, small businesses have struggled to provide quality, affordable health insurance for their employees.  According to the United States Bureau of Labor Statistics, this problem persists.  In fact, March 2012 data indicates that access to employer-provided benefits was significantly greater in medium and large businesses (500 employees or more) than in small businesses (100 employees or less), with health benefits available to only 57% of small business employees as compared to 89% of employees in larger businesses.  A “primary beneficiary” of the Exchange could be small businesses.

Thursday, November 1, 2012

The “Wild Wild West” Of SMS

SMS text messaging is fast becoming the preferred method of communication for many people who find it a quick and convenient way to share information with friends, family and, increasingly, colleagues.  This is true in the health care space as well with patients increasingly using text messaging to communicate with providers and to receive health-related reminders and updates, including for healthcare appointments, medication therapies and health news.  For example, anyone can text the word HEALTH to 87000 and begin receiving text messages from the Center for Disease Control regarding emergency alerts, new research and reports, as well as health information and tips.