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Medicare Revocation Appeals

There are five levels of appeals: determination, redetermination, ALJ Hearing, Medicare Appeals Council Review and Judicial Review. Click here to learn more.

Anti-Kickback Law

Just as it is illegal for you to take money from providers and suppliers in return for the referral of your Medicare and Medicaid patients, it is illegal for you to pay others to refer their Medicare and Medicaid patients to you. Click here to learn more.

RAC Program

The Tax Relief and Health Care Act of 2006 required a national RAC program for 2010. Whether or not you intended to overbill, the red flags are raised when health care providers submit claims that are not aligned with CMS coding policy. Click here to learn more.

HIPPA Compliance

The HIPAA Security Rule requires appropriate Administrative, Physical, and Technical Safeguards to ensure the confidentiality, integrity, and security of protected health information (PHI). Click here to learn more.

Latest Healthcare Law News

July 30, 2018 in Healthcare Law

Medical Necessity and RAC Audits

Medical Necessity and RAC Audits What is a medical necessity? According to a RAC Auditor (RA), it is something that is justifiably reasonable and necessary according to evidence-based clinical standards of care. According to who? Is this one-size fits all? How is this even possible? If you are not scratching…
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July 30, 2018 in Healthcare Law

Red Flags In Physical Therapy RAC Audits

Reg Flags In Physical Therapy RAC Audits Even if you're not currently under a RAC Audit, you might be wondering just how to stay out of trouble or not be "flagged" for an audit.  As much as you might have heard about the random nature of an audit, experience tells…
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July 25, 2018 in Healthcare Law

Billing Medicaid For Nutritional Counseling

Billing Medicaid For Nutritional Counseling Nutritional Counseling Program The nutritionist's goals are to enable health care providers to treat obesity as a disease and bill accordingly. Ul mately, this will help reduce obesity rates in South Carolina and improve health outcomes. The program is for: Adults with a body mass…
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July 3, 2018 in Healthcare Law

Georgia Medicaid Prepayment Review Status

Georgia Medicaid Prepayment Review Status Providers cannot appeal pre-payment review status, but can appeal denials of claims.  The appeal must be submitted within 30 days of the denial of the claim.  When a provider is on pre-payment review status, claims will only be paid if they comply with Georgia Medicaid…
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