tci Medicare Compliance & Reimbursement - 2015 Issue 7
Industry Notes: Proposed 'Doc Fix' Could See Congressional Vote
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Article Overview
This industry note reviews two Medicare-related developments of interest to billing and compliance professionals. The first section summarizes congressional activity around a proposed replacement for the Medicare payment formula and the broader policy debate over temporary payment fixes. The second section covers a federal enforcement case involving medically unnecessary services and repayment tied to alleged false claims. The article is relevant to providers, coders, compliance staff, and revenue cycle teams tracking Medicare policy and fraud-and-abuse enforcement.
Why This Topic Matters
It helps readers monitor major Medicare payment policy changes and understand how federal enforcement actions can affect billing compliance risk for physician practices and other providers.
Article Sections
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Proposed Medicare payment reform and congressional action
Summarizes legislative activity related to Medicare payment policy, including the push to replace temporary fixes and the broader discussion around long-term reimbursement reform.
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Unnecessary services lead to repayment case for New York doctor
Describes a Department of Justice enforcement matter involving alleged false claims tied to services billed to Medicare and the resulting repayment and sentencing issues.
What You Will Learn
- How Congress is approaching Medicare physician payment policy
- Why the proposed payment reform is drawing attention from medical associations
- How Medicare billing and medical necessity issues can lead to enforcement action
- What kinds of compliance risks are highlighted by a federal repayment case
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle professionals
- Physicians
- Practice managers
- Healthcare attorneys
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