Newly adopted Medicare regulations make it clear that Medicare intends to stop reimbursing hospitals for expenses associated with “hospital-acquired conditions”. Background Pursuant to the Deficit Reduction Act of 2005 (Pub. L. 109-171), the Secretary identified certain high cost and/or volume preventable conditions that result from inadequate hospital care and are identifiable by unique ICD-9-CM codes.
Last week, the New Jersey Department of Banking and Insurance (“NJ DOBI”) entered an order requiring Aetna to pay a fine of $9,457,500 for violating New Jersey’s HMO regulations regarding reimbursement for services rendered by non-participating providers. New Jersey HMO Law Pursuant to New Jersey law, an HMO must limit its members’ liability for services
A provider recently asked me whether she should register to receive Electronic Funds Transfer (“EFT”) and Electronic Remittance Advice (“ERA”) for her Medicare Part B claims. I answered “yes” and also encouraged her to consider registering for EFT and ERA with regard to any other payers with whom she participates. Since so many providers have
I am including below excerpts from an article I recently had published in Florida Medical Business Journal, Florida’s leading medical business journal. I apologize in advance to those who practice outside of Florida; however, most of the principles discussed in this article are applicable to doctors practicing in any state with the United States. Practicing