Physicians must do everything in their power to ensure that they remain complaint with federal rules and regulations governing everything from referrals to reimbursement. This also holds true at the state level, particularly when it comes to such matters as privacy and patient consent.
In our last post, we began exploring how the Centers for Medicare and Medicaid Services recently unveiled a proposal for a new Medicare physician payment model as part of a mandate included in legislation passed by Congress last year to overhaul the system.
The current Medicare physician payment system is set up in such a way that participants are paid based more on the quantity of care provided as opposed to the quality. In other words, they receive payments based on the number of treatments, tests and procedures they perform, as opposed to the amount of time they spend developing treatment plans or discussing issues with patients.
Today, we'll conclude our discussion of Medicare overpayments by taking a closer look at one of the more effective options available to those medical professionals blindsided by a demand letter from the Medicare Administrative Contractor: requesting an appeal.
In a series of ongoing posts, we've spent some time examining the process that unfolds when the Centers for Medicare and Medicaid Services discovers that a Medicare overpayment has been made to a medical professional.
While there's no disputing hospitals, clinics and standalone medical offices must manage a myriad of regulatory issues under both state and federal law, it's important to understand that they are not the only care-providing facilities with these concerns.
In our last post, we discussed how even the most diligent medical providers can sometimes make regulatory or administrative mistakes despite their best efforts, and how these mistakes can sometimes turn into decidedly difficult legal matters.
There is no question that medical providers have far too much on their plate as far as both regulatory and administrative matters are concerned. Indeed, the unfortunate reality is that no matter how hard individuals and organizations attempt to keep abreast of all changes or remain compliant with all regulations, mistakes can still occur.