medicaid Archive

Affordable Care Act Rules to Prevent Fraud: How Increased Vigilance Will Affect Your Practice

If you are wondering how the new healthcare law – the Affordable Care Act – will affect your practice, you are not alone. Providers across the country are trying to understand the implications that this new law will have on reimbursements and the practice of medicine.  Well, because the public is clamoring for my opinion

Being Dutiful About Compliance

Health care providers now more than ever must be proactive when it comes to addressing compliance and billing issues with Medicare and Medicaid.  Recently, federal and state governments have been devoting increased resources to detecting and combatting fraud in the health care industry.  At the federal level, both the Department of Justice and the United

CMS Issues Guidance to States for Medicaid Health IT Projects

The Centers for Medicare & Medicaid Services have provided state Medicaid directors with the federal government’s expectations while implementing the medical portion of the EMR incentive program. According to the incentive program, the eligible physician fulfilling the criteria of “meaningful use” will be provided with the full cost of Medicaid bonuses and 90% of the

Quality 101: A Guide to Quality Reporting by HIMSS

Quality and quality reporting are always referred to as the key elements in EMR incentives for meaningful use. HIMSS therefore has launched an online resource, called “Quality 101”, in order to assist the providers and vendors in better understanding the details behind these imperatives. The Patient Safety & Quality Outcomes Committee of HIMSS developed this

Steps Your Practice Can Take to Prevent Downcoding on Medical Claims

Almost all modern medical practices have experienced downcoding of their medical claims by insurance companies.  In simplest terms, downcoding describes the situation where a practice submits a claim based on a certain CPT code, but the insurance company automatically “downcodes” the claim to a code that effectively lowers the amount paid out to the physician. 

Doc Fix Medicare Legislation Postponed

This past weekend, President Barack Obama pressed Congress to pass Medicare legislation which would avert a planned 21.3% pay cut for doctors who see Medicare patients. The proposed Medicare “doc fix” bill was passed by the House but has been stalled in the Senate. The pay cuts were initially slated for June 1, but the