Last week, the Department of Justice (DOJ) announced a $516,718 false claims settlement related to improper billing of mid-level practitioner services using a physician’s provider number. Medicare reimburses nurse practitioner and physician assistant services at a reduced rate of 85% of the Medicare allowable when billed under the mid-level practitioner’s
CMS has issued updated guidance regarding the appropriate billing of drugs/biologicals. The new guidelines apply to all providers and are effective July 1, 2023. Providers who bill for drugs administered from a single-use vial are required to report one of the following modifiers on all claims: Modifer JW- Drug amount
Last week CMS announced enforcement updates related to hospital price transparency and issued a new fact sheet for providers. The hospital price transparency rules were effective January 1, 2021 and require hospitals to publish their charges for items and services in a specified, consumer-friendly format. CMS has been conducting audits of
On Tuesday, Inspector General Grimm made several important announcements during her presentation at the Healthcare Compliance Association’s Compliance Institute. Notable takeaways from her remarks include: 1. The OIG will be releasing updated compliance guidance for the first time since 2008. It is expected the guidance for Skilled Nursing Facilities and
The CMS released the 2024 Proposed Inpatient Prospective Payment Rule yesterday. Some notable changes for the upcoming year include: 2.8% increase in operating payments for acute care hospitals Individual hospitals may receive a 1% reduction for poor quality performance Individual hospitals may receive reductions for excessive readmissions Individual hospitals may
The Department of Justice (DOJ) has issued an update to their Evaluation of Corporate Compliance Programs (ECCP) guidance document. They have also announced a new “Pilot Program Regarding Compensation Incentives and Clawbacks” which requires compensation be tied to corporate compliance, effective March 15, 2023. The latest updates signal the government’s
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