News Updates

Medical Billing for the Dental Office

CMS-1500 Claim Form Step-by-Step Instructions

Dental carriers now require that any service that COULD be payable by any medical carrier, including Medicare; be submitted to the medical insurance first. Dental offices who have NEVER had to consider billing medical insurance are faced with the prospect of either being able to bill medical (correctly) or telling their patients that they will not assist them in getting the benefits, and possibly care, they deserve.

Healthcare Billing Fraud: 5 Latest Settlements

Here are five healthcare organizations that entered into settlements to resolve billing fraud allegations in the past two months:

 1. Acadia Healthcare inks $17M deal to settle billing fraud allegations

Franklin, Tenn.-based Acadia Healthcare entered into a $17 million settlement to resolve allegations its drug treatment centers in West Virginia submitted fraudulent claims for reimbursement to the state's Medicaid program.

 2. Maryland medical group settles false billing allegations

New Legislation Aims to Strengthen Stark Law

The Promoting Integrity in Medicare Act (PIMA) or HR 2143, has been introduced to Congress that seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.

The new legislation has been designed to have a direct impact on the services provided by physicians who self-refer for the performance of certain designated health services. If passed, PIMA would provide for increased penalties for Stark law violations involving the specified non-ancillary services.

"Appealing Delayed, Denied, and Reduced Claims" Webinar

Based on numerous client requests, we are now offering webinars for those unable to attend our live conferences or who want more detailed information on a specific subject. Our "Insurance Strategies and Compliance" webinar series is designed for providers that bill private and government insurance carriers. We teach you how to effectively and efficiently deal with insurance companies to ensure maximum payment. You will learn how to fix the most common issues providers deal with daily.

Billion-Dollar Medicare Fraud Bust

The FBI and Department of Justice officials today announced the disruption of one of the largest Medicare fraud schemes in U.S. history. An international fraud ring allegedly bilked Medicare out of more than $1 billion by billing it for unnecessary medical equipment—mainly back, shoulder, wrist, and knee braces. 

Dentists and Durable Medical Equipment

Medicare approves oral appliances as an accepted treatment for Obstructive Sleep Apnea. 

Lawsuit: Epic's Software Double-Bills Medicare, Medicaid for Anesthesia Services

Health IT giant Verona, Wis.-based Epic Systems has been hitwith a False Claims Act lawsuit that alleges the company's softwaredouble-bills Medicare and Medicaid for anesthesia services, resulting in thegovernment being overbilled by hundreds of millions of dollars.

Doctors Plead Guilty in Health Care Fraud Scheme

Updated: Apr 11, 2018 6:10 PM PDT

SAN DIEGO (CNS) - Two Tennessee doctors pleaded guilty in San Diego federal court Wednesday to participating in a health care fraud scheme that bilked TRICARE -- the health care program that covers United States service members -- out of more than $65 million by prescribing thousands of exorbitantly expensive compounded medications to patients that they never saw or examined.

Hospital Outpatient Billing, Coding, and Compliance

We have developed a conference for those that work in an outpatient setting within a hospital.


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Consequences for HIPAA Violations Don’t Stop When a Business Closes

A receiver appointed to liquidate the assets of Filefax, Inc. has agreed to pay $ 100,000 out of the receivership estate to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) in order to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.