Medi-Corp, Inc.

12/17/2012

Andre DiMino, who's been running medical device company ADM Tronics since 2001, has never laid off anybody. But come Jan.

12/12/2012

The American Society of Anesthesiologists is hoping the concept of the “surgical home” will help shelter its members from forces now buffeting the specialty, from ever-increasing quality care initiatives to the rise of accountable care organizations.

12/11/2012

Amid the 1,362 pages of the Medicare Physician Fee Schedule for 2013, issued by the Centers for Medicare & Medicaid Services (CMS) on Nov. 1, 2012, are 13 pages relating to a bitterly fought battle over benefits paid to certified registered nurse anesthetists. The final rule, which takes effect Jan....

12/06/2012

Practice Management - A column about keeping your practice in good health

12/06/2012

The Office of the National Coordinator for Health IT and the Centers of Medicare and Medicaid Services have revised aspects of their measures in the meaningful use Stage 2 final rule.

12/04/2012

Medicare paid providers billions to adopt electronic records without checking to see they're meeting quality goals

12/04/2012

Center investigation suggests cost from upcoding and other abuses likely tops $11 billion.

11/30/2012

11/30/2012

11/29/2012

11/29/2012

Audit Risk : Cloning

Noted in the recently released Work Plan, the OIG will be reviewing Part B E/M services for inappropriately paid claims. As stated in the plan, they will go back to 2010 when reviewing claims and documentation related to these services. They also plan to review multiple notes to determine if the inconsistencies are a result of EHR clone notes. Keep in mind that “clone notes” has always been a red flag for Medicare.

According to one of Medicare’s administrative contractors (National Government Services), “Cloned documentation will be considered misrepresentation of the medical necessity requirement for coverage of services due to the lack of specific individual information for each unique patient. Identification of this type of documentation will lead to denial of services for lack of medical necessity and the recoupment of all overpayments made.”

Cigna also published a notice to providers in a Medicare Bulletin in March/April 1999 and First Coast published their bulletin in 2006. According to these carriers, “Documentation is considered cloned when each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries. Cloning also occurs when medical documentation is exactly the same from beneficiary to beneficiary.

The message here is that cloning can and will mostly likely be construed as fraudulent conduct by the provider. The False Claim Act, was enacted during the Civil War to combat fraud against the federal government by suppliers to the Union Army. The Act, amended in 1986 and compasses both lack of medical necessity and False Certification of services by providers; which is the act of falsifying claims in order to obtain payments. Documentation of services should be unique to each patient’s specific condition as presented at time of services. Providers need to be involved with any process that creates templates that can lead to inappropriately documented services. Head in the sand concept does not work anymore.

11/29/2012

Zig Ziglar died today at age 86. A World War II veteran, Zig Ziglar became the top sales person in several organizations before striking out on his own as a motivational speaker and trainer. With a Southern charm and lessons grounded in Christianity, Ziglar wrote over two dozen books and [...]