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What Is Medical Billing Compliance?

Compliancy Group

One of the most common ways for providers and healthcare organizations to run afoul is to incorrectly or illegally bill and code for services or supplies. No matter the intent, noncompliance in medical billing can have severe consequences. It pays to know the law and avoid temptations to cut corners.

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Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

Compliancy Group

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Lawsuit Alleges Obamacare Plan-Switching Scheme Targeted Low-Income Consumers

Kaiser Health News

In turn, sales agents used the information to either enroll them in ACA plans or switch their existing policies without their consent. Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov.

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Reduced Co-Insurance for Screening Colonoscopies

Medisys Compliance

For dates of service on or after calendar year 2030, Medicare waives the coinsurance. In addition, the ACA amended Section 1833(b)(1) of the Act to waive the Part B deductible for screening colonoscopies, which includes moderate sedation services as an inherent part of the screening colonoscopy procedural service. Reference: [link].

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‘Free’ Screening? Know Your Rights to Get No-Cost Care

Kaiser Health News

Since late 2010, when this provision of the ACA took effect, many patients have paid nothing when they undergo routine mammograms, get one of more than a dozen vaccines, receive birth control, or are screened for other conditions, including diabetes, colon cancer, depression, and sexually transmitted diseases. The ACA does set parameters.

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A Health Consumer Bill of Rights: Assuring Affordability, Access, Autonomy, and Equity

Jane Sarashon

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

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Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?

Kaiser Health News

The former generally incurs no cost to patients under the ACA; the latter can generate bills. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed. Do you have an interesting medical bill you want to share with us?

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