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Joseph P. Galichia MD, the previous owner of the Wichita-based Galichia Medical, after quite some time, reached Fraud Claim Act settlements with the Feds in 2000 and 2009 amounting to nearly 6 Million Dollars. This was his third time settling with the US Federal Government for such behavior.
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The post Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years appeared first on The Coding Network.
The U.S. Department of Health and Human Services (HHS) workplace of inspector general (OIG) is within the business of finding out “fraud, waste, and abuse” within the nation’s health care system, to echo the oft-repeated phrase it uses to explain its mission. And business is booming. The Office of Inspector General is anticipating $ 2.9 billion in investigatory recoveries and slightly over half a billion additional in audit recoveries for the 2018 financial year, per a report recently delivered to Congress.
The post HHS Looking Forward to Almost $ 3.5 Billion in Fiscal Recoveries for 2018 appeared first on The Coding Network.
US Attorney Sherri A. Lydon made the announcement that the US Attorney’s Office for South Carolina has settled numerous claims of prolific health care fraud with Carolina Physical Therapy (also called “Carolina PT” for short). The company in question was a chain of nearly ten physical therapy practices headquartered in and around Columbia, Irmo, Lexington, Sumter, and Mount Pleasant.
The post Company Carolina Physical Therapy Will Pay almost $ 800K to Settle False Billing Allegations appeared first on The Coding Network.
Jefferson Medical Associates, a now broke down, multi-strength restorative practice bunch in Laurel, and Dr. Aremmia Tanious, have consented to pay the United States $ 817,635.06 to determine asserts under the False Claims Act emerging from Medicare excessive charges to Jefferson Medical Associates and Dr. Tanious, reported U.S. Lawyer Mike Hurst.
The post Tree Based Physicians Group and Neurologist Agree to Pay Almost One Million Dollars to Resolve False Claims Act Allegations appeared first on The Coding Network.
Josh Shapiro, Attorney General, announced that a Johnstown plastic surgeon pleaded guilty today to two felonies. The surgeon bilked private insurers and the Medicaid program out of almost $ 300,000 by routinely billing Medicaid and private insurers for cancer treatments – even when the growths were not cancerous.
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The post Cambria County Plastic Surgeon Pleads Guilty to almost $ 300K in Medicaid and Insurance Fraud appeared first on The Coding Network.
Almost two-thirds of the hospitals surveyed in 2017 were found noncompliant in at least one—and possibly many more—of the top 10 most challenging standards for hospitals.
There’s no more excuses for getting ready to meet the new emergency preparedness Conditions of Participation (CoP). The final version of the rules came out in late June, and surveyors with CMS and The Joint Commission will begin assessing compliance with the new emergency management (EM) CoPs on November 15, regardless of the revision timetable.
CMS first announced the new CoPs in September 2016, which compel hospitals to communicate and coordinate their emergency plans with other hospitals and government agencies. They also require regular emergency preparedness training with staff and disaster contingency planning. CMS published the final version of the new Appendix Z of Medicare’s State Operations Manual online, and state surveyors will use newly created E-tags to score deficiencies and expectations set in it.
While many providers had been waiting for the final guidelines to come out before working to meet the new emergency preparedness requirements, note that the new 72-page appendix might not be as helpful as hoped. The guidelines are not separated out by provider type but rather by the CoP, Condition for Coverage, or Condition for Certification (CfC) that was set out in the final rule issued September 2016.
You should also remember that the version online could “vary slightly” from the advance guidelines published June 2. However, the online version is the final policy, so you will need to check it to reconcile policies and procedures if necessary.
E-tags separated by provider
The final rule is divided by provider type, and each E-tag has different expectations outlined depending on provider. That means you’ll have to select which part of the E-tag applies to your facility, notes Frank Ruelas, facility compliance professional at St. Joseph’s Hospital and Medical Center/Dignity Health in Phoenix. And that gets a little busy to read, he says, but when in doubt one should still turn to the final rule for guidance.
“Sometimes one can find very useful information to help clarify questions that come up when reviewing these requirements,” he says.
Look to the provider-specific sections of the final rule for explanations. “Using this approach can take a lot of the mystery out of what needs to be done,” Ruelas observes.
The Joint Commission is working on revisions to its EM standards chapter in light of the new CoPs.
Long time coming
Work on the new EM Interpretive Guidelines has been ongoing since 2014, and CMS has been warning healthcare organizations (HCO) since 2016 not to hold off on preparing for them—especially those HCOs required to meet the annual emergency preparedness exercises set forth in the September 2016 final rule establishing the CoPs or CfCs.
Most organizations are required to conduct two exercises per year, including at least one full-scale drill involving the local community or, if that is not possible, the entire facility.
Certifications
Chemeketa Community College:
Medical Coding and Billing Certificate
6/11 Deans List
Health Information Tech. Certificate
6/11 Deans List
Western Oregon University:
Bachelors of Science in Health
Education 2001
Relevant Course:
ICD-10 CM Coding/Reimbursement
CPT-IV Coding/Reimbursement
Advanced CPT- IV Coding
Advanced ICD-10-CM Coding
Medical Terminology
Human Diseases
Health Information Systems
Medical Insurance Billing
Medical Law and Ethics
Selected Accomplishment:
Selected to be a consultant for the ICD-10 change over for October 1, 2015
Medical coding/billing SPECIALIST
Multi-Educated Professional seeking employment in a Remote Medical Office Setting Part-Time
PROFILE
Accomplished, well-rounded coding/billing professional seeking an employment position in Healthcare remote office setting. Self-motivated, innovative, and hard-working individual. Dependable, with a genuine interest for medical coding.
Software:
EPIC, NextGen, Optum, Meditech, Epremis, TruCode, SuperCoder, Healthland, GE Centricity, MS Office (Word, Excel, Outlook, Access, PowerPoint)
Diagnostic Imaging 2016 to present
Medical Coder
Assigned ICD 10, CPT, and HCPC codes to all billable visits (Interventional and Diagnostic Imaging)
Trained and mentored prospective coders to the radiology practice.
Reviewed clinical documentation for completeness and billable to insurance.
Assisted the accounts receivable with claim denials and CCI edits.
Communicated and educated the providers regarding coding rules and documentation issues.
Hope Orthopedics 2014-2016
Coding Specialist
Assigned ICD 10, CPT, and HCPC codes to all billable visits (office visits, ED visits, consults, outpatient procedures, etc.)
Reviewed clinical documentation for completeness and billable to insurance.
Assisted the accounts receivable with claim denials and CCI edits.
Communicated and educated the providers regarding coding rules and documentation issues.
In-house consultant for the orthopedic group for the ICD-10 change-over
Samaritan Health Services 2011-2014
Charge Master HIM Coder/Analyst (CDM)
Monitor unbilled accounts and report for outstanding and/or un-coded discharges to reduce AR days.
Abstracts pertinent information from patient records for coding/billing purposes.
Liaison between Application Coordinators and Medical Records for charge issue database.
Verify requested charge issues, CPT codes, and patient information before submitting to processing.
Assist in all set up and changes to pricing and procedure code tables.
~ Positive Attitude ~ ~ Detail Oriented ~ ~ Organized ~ ~ Problem Solver ~