decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Fraud and Abuse / Additional risk areas
Subscribe or sign in to view the full article.
Article Overview
This article summarizes a set of additional fraud-and-abuse risk areas that physician practices may want to include in their compliance programs. It is relevant to physicians, practice managers, compliance staff, and billing personnel who work with Medicare, Medicaid, and other federal health care program requirements. The discussion covers broad categories such as coverage and billing concerns, advance beneficiary notices, physician certifications, emergency department obligations, teaching physician issues, incentive and rental arrangements, third-party billing services, and advertising practices tied to federal program names.
Why This Topic Matters
These risk areas can affect claim payment, refund obligations, civil monetary penalties, exclusion risk, and broader compliance exposure for physician practices. Understanding the scope of the issues helps organizations strengthen internal policies and reduce the chance of billing, referral, or promotional practices that may draw scrutiny.
Article Sections
-
Additional risk areas for physician practices
Introduces the appendix-style list of risk areas and places them in the context of physician practice compliance programs.
-
Billing, coverage, and notice-related issues
Covers topics related to covered services, beneficiary notices, certification requirements, and handling claims involving non-covered services or payment denials.
-
Emergency care and teaching physician considerations
Discusses emergency treatment obligations and compliance issues that arise in teaching settings.
-
Financial arrangements and referral risk
Addresses concerns involving hospital-physician arrangements, incentives, billing models, professional courtesy, and rental relationships that may raise fraud-and-abuse issues.
-
Advertising and public representations
Summarizes restrictions on promotional practices that could imply endorsement by federal health care entities.
What You Will Learn
- The broad compliance areas that physician practices should consider beyond the main fraud-and-abuse risk categories.
- How billing, notice, certification, and denial-related issues fit into a compliance program.
- Why emergency care, teaching physician, incentive, and rental arrangements can create oversight concerns.
- What types of advertising and public representations may raise federal program concerns.
Who Should Read This
- Physicians
- Medical practice managers
- Compliance officers
- Medical coders
- Billing staff
- Healthcare attorneys
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com