ED Coding & Reimbursement Alert - 2013 Issue 43
Compliance: Get These 3 Compliance Answers Straight From CMS
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Article Overview
This article summarizes three CMS-issued compliance answers for Medicare providers and billing staff. It discusses broad compliance topics such as physician self-referral, emergency department encounters that end before physician evaluation, and hospital decisions about deductibles and coinsurance, with emphasis on how CMS and related oversight guidance frame these issues. The piece is aimed at practices, hospitals, and compliance personnel who want a plain-English overview of common risk areas and the kinds of federal rules involved.
Why This Topic Matters
These are recurring Medicare compliance concerns that can affect referrals, emergency department billing, and hospital financial policy. Understanding the general CMS guidance helps organizations recognize when an issue may raise regulatory risk and when additional review is warranted.
Article Sections
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Physician self-referral law overview
Introduces the first compliance question and summarizes CMS guidance on physician self-referral and related Medicare restrictions. The section also notes the role of exceptions and refers readers to CMS resources.
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Emergency department visit when the patient leaves before physician evaluation
Addresses a common emergency department scenario involving nursing triage and a patient departure before physician assessment. The section explains the broader Medicare coverage and service-setting issues discussed by CMS.
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Hospital write-offs of deductibles and coinsurance
Reviews CMS and OIG-related discussion of hospital handling of Medicare cost-sharing amounts. It focuses on the compliance context around waivers, charity care, and related federal fraud-and-abuse concerns.
What You Will Learn
- How CMS frames common Medicare compliance questions
- The general scope of physician self-referral concerns
- Why some emergency department encounters raise Medicare billing issues
- How hospitals may approach uncollected patient cost-sharing in compliance discussions
- Where federal fraud-and-abuse guidance intersects with Medicare billing policies
Who Should Read This
- Physician practices
- Hospital billing and compliance staff
- Revenue cycle teams
- Healthcare administrators
- Medical coders and auditors
Codes Discussed
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