ABSTRACT
Standard-form software and hardware contracts need critical review to ensure that the product meets the needs of the practice.
Subject(s)
Computers/legislation & jurisprudence , Contracts/legislation & jurisprudence , Office Automation/legislation & jurisprudence , Software/legislation & jurisprudence , Computers/economics , Contracts/economics , Costs and Cost Analysis/economics , Humans , Licensure/economics , Licensure/legislation & jurisprudence , Maintenance/economics , Maintenance/legislation & jurisprudence , Office Automation/economics , Software/economics , United StatesABSTRACT
In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.
Subject(s)
Medicare/legislation & jurisprudence , Office Management/organization & administration , Patient Credit and Collection/organization & administration , Reimbursement Mechanisms/organization & administration , Delivery of Health Care/legislation & jurisprudence , Delivery of Health Care/organization & administration , Humans , Office Management/legislation & jurisprudence , Outpatient Clinics, Hospital/legislation & jurisprudence , Outpatient Clinics, Hospital/organization & administration , Patient Credit and Collection/legislation & jurisprudence , Physicians' Offices/legislation & jurisprudence , Physicians' Offices/organization & administration , Practice Patterns, Physicians'/legislation & jurisprudence , Practice Patterns, Physicians'/organization & administration , Reimbursement Mechanisms/legislation & jurisprudence , United StatesABSTRACT
This article describes Medicare's recent Integrity Program effort, the Zone Program Integrity Contractors (ZPICs). The ZPICs are replacing the existing Program Safeguard Contractors and are part of Medicare's effort to enhance its auditing capabilities through centralization of audits and identification of potentially noncompliant activities. The ZPICs are currently active in three of the eventual seven zones, and through their active pursuit of fraudulent activities have already demonstrated their zealous intent to investigate potential fraud. ZPICs in all seven zones are scheduled to open by year end.
Subject(s)
Centers for Medicare and Medicaid Services, U.S. , Contract Services , Fraud/prevention & control , Insurance Claim Review , Medicare , Humans , United StatesABSTRACT
Senator Pete Stark, sponsor of the Physician Self-Referral Law, was recently quoted as saying he wished he had never sponsored the law due to its now complex requirements and iterations imposed by the Centers for Medicare & Medicaid Services. The new Stark II Phase III rules further muddy the waters. This article reviews the basic Stark prohibitions and provides an overview of Stark II Phase III.
