Reimbursement Archive

Medicare will Deny Claims Relating to Hospital-Acquired Conditions

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.

NJ DOBI Orders Aetna to Properly Reimburse Non-participating Providers

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

Why utilize ERAs and EFTs?

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

Practicing Preventive Legal Medicine

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