Download or read book Provider based Entities written by Gina M. Reese and published by Hcpro, a Division of Simplify Compliance. This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book serves as a comprehensive guide to provider-based clinics, from qualifying under CMS, to unique billing and coding rules, and the business decisions behind owning or acquiring these clinics. It will help readers sort through the complex regulations relevant to this unique provider type, and provide insight into recent changes, such as the introduction of Modifier -PO. CMS is looking to implement the Section 603 provisions of the Bipartisan Budget Act of 2015 regarding off-campus, provider-based departments (PBD) by January 1, 2017, according to the 2017 OPPS proposed rule. The agency is proposing to pay the nonfacility or office Medicare Physician Fee Schedule (MPFS) amount to the performing/supervising physician and preclude hospitals from billing on a UB-04 form or receiving OPPS payment for services performed at these locations for 2017, but plans to explore other options for 2018 and beyond. Physicians would be paid at the higher nonfacility rate of the MPFS, but only hospitals that have employed or contracted physicians that reassign their billing to the hospital would get paid under the MPFS for these services. Hospitals would be able to bill claims on CMS-1500 forms for physicians who have already reassigned their billing to the hospital, as in the case of employed physicians. Otherwise, hospitals would have the option of enrolling the location as the type of provider or supplier it wishes to bill to meet the requirements of that payment system (e.g., ambulatory surgery center or group practice).
Download or read book Understanding Provider Based Status written by Cherilyn G. Murer and published by Wolters Kluwer. This book was released on 2003-01-01 with total page 240 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Compliance for Coding Billing Reimbursement written by Duane C. Abbey and published by CRC Press. This book was released on 2008-04-02 with total page 232 pages. Available in PDF, EPUB and Kindle. Book excerpt: While the vast majority of providers never intend to commit fraud or file false claims, complex procedures, changing regulations, and evolving technology make it nearly impossible to avoid billing errors. For example, if you play by HIPAA‘s rules, a physician is a provider; however, Medicare requires that the same physician must be referred to as a
Download or read book The CMS Hospital Conditions of Participation and Interpretive Guidelines written by and published by . This book was released on 2017-11-27 with total page 546 pages. Available in PDF, EPUB and Kindle. Book excerpt: In addition to reprinting the PDF of the CMS CoPs and Interpretive Guidelines, we include key Survey and Certification memos that CMS has issued to announced changes to the emergency preparedness final rule, fire and smoke door annual testing requirements, survey team composition and investigation of complaints, infection control screenings, and legionella risk reduction.
Download or read book CodeBusters written by Patricia T. Aalseth and published by Jones & Bartlett Learning. This book was released on 1998-12 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicine
Download or read book Conditions of Participation for Hospitals written by United States. Social Security Administration and published by . This book was released on 1966 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
Download or read book State and Federal Prohibitions on Physician Referrals written by Robert W. McAdams and published by Aspen Publishers. This book was released on 1998 with total page 466 pages. Available in PDF, EPUB and Kindle. Book excerpt: Federal and state law restrictions on financial relationships between health care providers have undergone significant growth in the past decade. As the health care industry consolidates to form managed care systems and networks of providers, the financial relationship between providers becomes crucial in determining what referrals, marketing strategies, and billing practices are permissible. Defining the boundaries of permissible conduct under a myriad of statutes at both the federal and state level has become a difficult undertaking. This manual offers a variety of tools to assist attorneys and providers in understanding the complexities of the so-called Stark laws and regulations as well and presents a comprehensive state-by-state review of referral laws. Definitions, hypothetical case studies, full text of laws, regulations, and advisory opinions, corporate compliance polices relating to physician referrals, and checklists for determining the legality of specific financial arrangements make this an invaluable resource.
Download or read book Health Care Fraud and Abuse written by Hoyt W. Torras and published by American Medical Association Press. This book was released on 2001 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: In recent years, the federal government has become more aggressive in pursuing health care fraud & abuse... This new publication will help physicians understand the recent legislation and will identify concrete steps that should be taken to create & implement compliance plans. Includes: -- Steps for implementing a compliance program to ensure billing accuracy while actually helping to increase revenue -- Checklists, tables & forms to help with actual implementation of a compliance program -- Case studies and real world examples of the effects of recent legislation -- Tailor-made compliance programs for both large and small practices -- Practical suggestions for minimizing the risk of audit.
Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 10 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
Download or read book The Hospice Guide to Billing and Reimbursement written by Casey Fenton and published by . This book was released on 2016-07-21 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape Casey Grimes Catherine Stapleton, MS The industrywide march toward standardized performance measurement and unified value-based payment structures requires hospice agencies to stay on top of CMS regulatory guidance. "The Hospice Guide to Billing and Reimbursement"is your comprehensive solution to implementing accurate, compliant, and competent billing practices at your organization. This book will help you provide the best training possible to your administrative staff and those who impact billing, increasing their competence and confidence about billing requirements and practices. It will equip providers with the broad frameworks and processes needed to develop billing systems and financial plans that meet CMS ever-sharper scrutiny. This book will help you understand: Regulators expectations surrounding billing and reimbursement for the Medicare hospice benefitRecent updates to payment terms, such as the introduction of the Service Intensity Add-on (SIA) and the two-tiered reimbursement structure for the provision of routine homecareWhat you need to do to prepare for the major changes still ahead (e.g., value-based purchasing models)How not to leave money on the table or be penalized unnecessarily Table of Contents: Today s Hospice Reimbursement and Billing Landscape at a GlanceOverview of the Medicare hospice benefitFoundations of hospice billing and reimbursementKey developments in recent yearsLarge-scale changes on the horizonLinking Hospice Philosophy, Care Practices and Outcomes, Operational Processes, and Received PaymentPromoting Ongoing Compliance With Long-Standing Components of Hospice Payment and BillingHonoring patient eligibility requirementsUnderstanding sequential billingDistributing Medicare coverage noticesCreating effective cost reportsResponding to additional development requests (ADR)Withstanding auditsAdapting Practices and Processes to Accommodate Recent, Industrywide Payment Rate and Process ChangesThe SIA and two-tiered RHC payment model introduced through 2016 rulemakingRecent adjustment to hospice caps calculation methodologyIntegrating the hospice PEPPER report (including recently updated coverage areas) into internal billing compliance initiativesAdhering to quality reporting expectations to avoid payment penaltiesPromoting timely filing of election notices and recertifications, as well as timely completion of face-to-face documentationCurbing high rates of recertification and revocationImplementing effective compliance strategies surrounding the launch of ICD-10 and general coding-related practices (including clinical documentation) that can influence paymentRecognizing and Readying Internal Systems for the Prospective Impact of Continuumwide Payment Reform InitiativesValue-based purchasingBundled paymentsAccountable care organizations (ACO)Implementing Enduring Billing Best Practices, Strategies, and Systems to Facilitate the Receipt of Deserved ReimbursementComplying with setting-specific guidelines, rules, and regulations, especially those governing hospitals, skilled nursing facilities, and assisted living facilitiesDeveloping effective initial and ongoing staff training"
Download or read book Documentation Guidelines for Evaluation and Management Services written by American Medical Association and published by American Medical Association Press. This book was released on 1995 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Benefits Coverage Under Federal Law written by and published by . This book was released on 2007 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Hospice Manual written by and published by . This book was released on 1992 with total page 178 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Instructions to Surveyors written by Great Britain. Board of Trade and published by . This book was released on 1909 with total page 98 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Download or read book Evidence Based Medicine and the Changing Nature of Health Care written by Institute of Medicine and published by National Academies Press. This book was released on 2008-09-06 with total page 202 pages. Available in PDF, EPUB and Kindle. Book excerpt: Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
