Search Results for: private overpayment

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements?

Dental Audits & Compliance /

(January 3, 2019): Slowly but surely, the percentage of adults and children with dental insurance coverage benefits has gradually climbed. These increases have been driven, at least in part, by several factors. First, despite the fact that traditional Medicare does not cover routine dental services, a number of Medicare Advantage plans are now offering coverage […]

Aetna’s SIU is Actively Auditing Dental Claims. Are Your Dental Services Compliant with Applicable Regulatory and Contractual Requirements? Read More »

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements?

Medicare, Medicaid & Private Payor Updates /

(Updated September 22, 2019): The use of “telehealth” technologies to diagnose and treat patients can be used to address provider shortages, improve patient access to otherwise unavailable specialized services, reduces costs, and provides an effective way to monitor the status of patients from long distances. The many benefits of telehealth have been readily recognized by

Audits of Telehealth Services are Increasing. Do Your Telehealth Services Meet Applicable Requirements? Read More »

Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered

Dental Audits & Compliance /

(December 7, 2018): Each state sets their own licensure requirements, rules and regulations regarding the practice of dentistry, all of which are subject to change. While there are differences from state to state, the approach taken by most states with respect to the practice of dentistry is fairly consistent. After conducting a review of several

Mobile Dentistry in Texas – An Overview of Regulatory Risk Areas to be Considered Read More »

Areas of Practice

Health Care Law Liles Parker attorneys have the litigation experience, health care regulatory knowledge, and counseling skills necessary to efficiently resolve health care issues at the lowest possible level, before they escalate into a more significant problem Learn More Unified Program Integrity Contractor (UPIC) Audits HIPAA Audits and Compliance False Claims Act Matters and Cases

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Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant?

Medicare, Medicaid & Private Payor Updates /

(July 16, 2018): Do you provide Transcranial Magnetic Stimulation care and treatment services? If so, you need to ensure that your medical necessity, documentation, coding and billing practices fully comply with applicable statutory, regulatory and administrative guidelines. In recent weeks, a flurry of prepayment review letters from Medicare Administrative Contractors (MACs) have been sent to

Transcranial Magnetic Stimulation Claims Audits by Medicare MACs and UPICs are Underway. Are Your CPT 90868 Claims Compliant? Read More »

Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit?

Medicare, Medicaid & Private Payor Updates /

(July 12, 2018): While no medical specialty has completely avoided the scrutiny of law enforcement and government contractors, for the most part, OB/GYNs and Urogynecologists have managed to stay out of the limelight of auditors and investigators tasked with identifying improper billing practices. Unfortunately, those days appear to be over. Working closely with the staff

Is Your Urogynecology, OB/GYN or Multidisciplinary Practice Prepared for a Medicare Biofeedback Claims Audit or a Pelvic Floor Therapy Claims Audit? Read More »

UPIC Dental Audits (Such as Qlarant Dental Audits) Have Been Initiated. Is Your Practice Ready for its Medicare Dental Claims or Medicaid Dental Claims to be Audited?

Dental Audits & Compliance /

(July 3, 2018): While a number of Medicare Advantage Plans now offer supplemental coverage for preventive, basic, and major dental services, only a narrow category of dental services qualify for coverage and payment under standard Medicare Part A (pursuant to Section 1862(a)(12) of the Social Security Act). Presently, only qualifying Medicaid beneficiaries are likely to

UPIC Dental Audits (Such as Qlarant Dental Audits) Have Been Initiated. Is Your Practice Ready for its Medicare Dental Claims or Medicaid Dental Claims to be Audited? Read More »

An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions

Medicare, Medicaid & Private Payor Updates /

(May 20, 2018): It’s been a rough week for at least one Texas rheumatologist. Last Monday, the U.S. Attorney’s Office for the Southern District of Texas announced the indictment of a South Texas rheumatologist for multiple counts of health care fraud and one count of conspiracy to commit money laundering. The magnitude of the alleged

An Overview of Administrative Rheumatology Audits / Adverse Actions AND Civil / Criminal Enforcement Actions Read More »

Expect an Increase in Audits of Chiropractic Services!

Medicare, Medicaid & Private Payor Updates /

(April 16, 2018): Chiropractors around the country are again finding their services and claims under intensive scrutiny from Medicare contractors and investigators, despite the fact that only three services even qualify for coverage and payment. Several weeks ago, the Department of Health and Human Services (HHS), Office of the Inspector General (OIG) released its latest

Expect an Increase in Audits of Chiropractic Services! Read More »