5% criminal convicts

Hospitals Waste Valuable Resources Fighting Unfounded Denials by RACs (excerpt)

AIS’s Health Business Daily, February 25, 2011

Reprinted from Report on Medicare Compliance

Some compliance officers continue to fight denials from recovery audit contractors that they say defy logic, and are frustrated with the lack of feedback from RACs that hospitals could use to improve their claims submissions ….


The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago

Reprinted from REPORT ON MEDICARE COMPLIANCE, February 21, 2011

The Medicare Fraud Strike Force has expanded its operations to Dallas and Chicago, the Department of Justice said Feb. 17.  That means the DOJ-HHS fraud fighters are now in nine cities.  DOJ also announced the largest-ever takedown with 111 defendants, who were charged for their alleged participation in schemes to defraud Medicare of $225 million.  The defendants include doctors, nurses, health care company owners and executives, and others.  Read more at www.justice.gov.


OIG Report (excerpt)

Nursing Facilities’ Employment of Individuals With Criminal Convictions



Our analysis of criminal history records maintained by the Federal Bureau of Investigation (FBI) revealed that 92 percent of nursing facilities employed at least one individual with at least one criminal conviction.  Overall, 5 percent of nursing facility employees had at least one criminal convictions.


Magic Number for Medical Record Retention is 6 years, CMS Says

Medicare Compliance & Reimbursement

Eli Research Vol. 36, No. 20


If your state laws require a period longer than that, then that’s the time required, but six is the federal minimum.

Medical practices often hear conflicting advice regarding how long they must hang on to a patient’s medical records, but CMS intends to clear up any misinformation with new MLN Matters article SE1022, issued this month.

Although many physicians follow state laws when determining whether they can discontinue retaining a patient’s records, it’s important to keep in mind that you must hang onto the patient’s records for at least six years, according to HIPAA laws.  If your state requires a period longer than that, you must extend the length of time to meet state laws, but six years is the federal minimum.

“HIPAA administrative simplification rules require a covered entity, such as a physician billing Medicare, to retain required documentation for six years from the date of its creation or the date when it last was in effect, whichever is later,” the MLN Matters article states.  “HIPAA requirements preempt state laws if they require shorter period.  Your state may require a longer retention period.”

If you submit cost reports, you must retain the original or copies for at least five years following the cost report’s closure, and Medicare managed care programs providers must retain records for ten years, the article notes.

To read the complete MLN Matters article on record retention, visit www.cms.gov/MLNMattersArticles/downloads/SE1022.pdf.


Receive a 10% discount on AudioEducator events when you use the promo code BDINCNL during checkout.  (Web orders only.)

Upcoming Events from AudioEducator — April 2011
Dates Title Webpage List Price
April 5 How to Use Mid-Level Providers to Get More Work Done and More Revenue In Details $197
  2011 Cardiology Coding Updates and Techniques Details $197
  There’s a Monster Hiding IN Your Organization and its Name is “Identity Fraud” Details $249
April 6 Anesthesia Compliance: Self Audit or RAC Penalty? Details $197
  Courtroom Testimony Tips, Pointers & Commandments for Healthcare Professionals Details $197
  The Move from Facilities to Home: Is it All Good News for Home Health? Details $197
April 7 The ABCs of Incident-to & Shared Billing: Update 2011 Details $197
  Hospitals: Check and Double-Check Your Coding for Drug Administration Services Details $197
April11 Steer Clear of Penalties with Easier and More Effective HIPAA Risk Analysis Details $249
April 12 New Changes to HIPAA: The latest regulations and what they  mean to you Details $249
April 13 Medical Review – Key Steps in the ADR Process Details $197
HIPAA Business Associates Rules – What They Mean for BAs and You Details $249
April 14 Observation Services Demystified Part 2: Advanced Concepts You Need to Know Details $197
  HITECH and HIPAA – The Final Rules Details $249
  Linking Work and Revenue: What You May Not Know (But Should) about Basic Coding Details $197
  Diabetes Coding Essentials for Home Health – What You Need for Accurate Reimbursement Details $197
April 15 “Email that to me.” – Electronics, Health Information, and HIPAA Details $249
April 19 Diagnosis Coding for Anesthesia, Including ICD-10 Implementation Details $197
  Nursing and Physician Documentation in the ED: How to Bridge the Gap for Facility and Professional Coding Details $197
  Treat ‘Em Right — Using Customer Service to Increase Patient Volume Details $197
  Taking the Guesswork Out of Pelvic Reconstruction Surgery Details $197
April 20 How to Clearly Establish Homebound Status and Guarantee Medicare Coverage Details $197
  Modifier Knowledge: Learn to Append for Otolaryngology Details $197
April 21 Evaluating Child Abuse and Neglect for Care Providers Details $197
  Know Your Audit Risk Areas before the RACs Do: 2011 Update Details $249
  Electronic Discovery Meets Healthcare Information – Don’t Lose Thousands in Litigation Details $249
  PQRI – The Basics: Efficiently Identifying and Reporting Measures Details $197
April 26 Maximize Reimbursement for Orthopedic Repair of Tendons, Blood Vessels and Nerves Details $249
  Modifiers 25 and 57 – Are You Using Them Right or Just Trying to Unbundle? Details $197
April 27 Urology Coding101 prostate treatment coding and related procedures Details $197
  Plug Revenue Leaks with Financial Policies and Reimbursements Tips that Really Work Details $249
  Hold Tight to Your Practice’s Revenue with These Vital ERISA Basics Details $197
April 28 Cardiology Coding Update for 2011 Details $197
  Claim Boosters: Bridge the Gap between Medical Billing and Medical Coding Details $197
  Document and Bill for Non-Physician Practitioners Details $197

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