Healthcare Operations Training – Plano, TX – November 12-13, 2013


Mark your calendar, this healthcare training will revolutionize your operations management processes and improve your collections and accountability. We have limited seating available for this intense training on managing the healthcare office environment more efficiently during the trying times of reimbursement cuts, commercial contracts being closed to new providers, audits and investigations from every corner. We know these two days will be intense, but you will leave with viable information and forms to put in place on Thursday upon your return. All speakers have many years experience in the DME and Physician market from operations to audits and investigations.  Lunch is included both days.

Topics to be covered:  Start-ups, ICD-10 preparedness, Accountable Care Organizations (ACO), audits and how to prepare, retail selling, contracting, monitoring billing/revenue reports weekly, monthly, yearly, getting the most out of your EMR or billing software system, employee accountability, and more.

November 12 – Is designed to be applicable to any healthcare provider, physicians, dentist, DME, or Home Health. All providers can benefit from the training to have a more efficient office.

November 13 – Is designed specifically to address billing and collection problems in the DME industry.  We have a program on commercial insurance contracting, system reports, new start up DME process and more.  The building does have wi-fi, bring your computers for interactive sessions.

Read the full program here at this  Healthcare Operations Training Dallas TX Nov 12 13 2013

We are still working out a discount with the hotel and transportation company, so please register below as soon as possible and return the attached Healthcare Training Dallas TX Registration Nov 12 13 2013 packet completed by 10/30/13. In order to get the best discount possible, we need head count. We have worked out some discounts for coding books and such for those that register, with additional information coming in.

Register below for Training Nov 12- 13 2013 to pay by credit card all other payments may be made by mailing the Registration Packet to our office. If your are only registering 1 attendee, please register at the link below. If you have more than 1, please contact us so discount is calculated appropriately.

Health care Training November 2013

Sponsors include:Texas Capital Bank

strategic ar logo

OIG Work Plan 2012


I participated in a call on Thursday January 19, 2012, on the OIG Work Plan for 2012.  Please reference the link for the full OIG Work Plan spelled out by provider type.  Many items on the Work Plan never change but there were a few points I felt important to draw your attention to for risk management purposes.  Here are a few notes I made because I think the audit risk is high since the result can be subjective:

1.  Outpatient Observation Billing

2.  Critical Access Hospitals:

A.  Distance to nearest, non-critical access hospital

B.  Herceptin and other Chemo Drug quantity

3.  Hospice because 82% of patients do not meet criteria to be admitted to hospice.

4.  Incident to Services by non-qualified personnel.  Even Blue Cross and Blue Shield is recouping and extrapolating on commercial claims for mid-level practitioner billing.  Make sure modifier is used when appropriate and the mid-level meets the licensing requirements to provide the services billed.

5.  Off Label Prescriptions.  Physicians ordering a drug that is approved for Diagnosis A but the drug is used for diagnosis B.

6.  Home Health-but not specific because they are going to review 2010 billing before they decide.

7.  Dialysis and ESRD Drug costs.  What is the drug cost to the provider versus the reimbursement.

8.  Contracts providers have with other providers/facilities.  Make sure you have a health care attorney to review the contract before executing because the health care attorneys are familiar with the Stark and Anti-Kickback provisions which typically the corporate business attorney does not have to consider.

9.  Checking employees, vendors, and providers against Sanction Databases MONTHLY.  You may find the federal links on my website.  The states have their own links.

10.  NY Medicaid reduced the annual revenues to $500K in Medicaid/Medicaid HMO/Managed Care Organizations (MCO) funds for compliance program requirement.

11.  Compliance Program Requirement under Federal Deficit Reduction Act that required all healthcare providers to have a compliance program in place by 2007 if their annual collected revenue of State reimbursement was $5M or more.  This would include Medicaid and respective Medicaid HMO or MCO.

12.  As of 2013 a healthcare compliance program is required for all providers billing Federal or State plans no matter what the annual billing revenue may be.  This would include dental practices because they bill Medicaid!

13.  Overpayments must be disclosed and refunded within 60 days of identification that it is an overpayment.  Failure to refund this money can result in “False Claims” charges and penalties.  Ensure you have someone that is accountable for working your credit balance reports monthly.  Keep documentation of these reviews and refunds issued as a result in a manner that can easily be explained and found.

The OIG Work Plan can be used to determine risk analysis, structure audit plans, and determine growth opportunities.

Do you have a Healthcare Compliance Program?

Do you review the OIG Work Plan Annually?

What else do you review to determine your audit plan?

We can help you analyze the status of your healthcare compliance program and ensure you have focused on the correct risks for your business model.  We are the compliance expert with a vast history and a cost effective way to ensure your compliance program is operating and managing your risk.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Star 10R Training: Identify Dementia Signs Early & Even Prevent Dementia


Star 10R Training Seminar for Caregivers

We know the sacrifice that Caregivers make for their loved ones. Our organization looks for resources to help providers and caregivers  care for your loved ones. We have met with AFFECTS a Texas based entity that is well known for Innovation, Creativity and Entrepreneurship, and definitely not a traditional company by any means.

We hope you are excited!  Mr. Ray Ashton who is the Founder of this highly progressive company out of Houston is very passionate about his innovative training.  This life long mission was sparked because his grandmother passed away after years of suffering from Dementia.  Read more about Mr. Ashton.  He actually coined the term,  “Preventive Wellness” about 22 years ago.  His healthcare company, STAR Preventive Wellness (AFFECTS LLC), is training the Healthcare professional across the country with main focus on Geriatric and Early Stage Dementia, in particular.  His idea is to train the Communities’ own staff (or individuals) including RN’s, LVN’s and just about anyone who works with Seniors including Case Managers, Administrators or Social Workers. His 8-Hour CEU training is really a must for anyone who works at Memory Care, Assisted Living or Skilled Nursing communities.

They have 2 meetings planned this summer:
Hosuton Class Information
Dementia Education Houston, Texas

One is being planned for the Dallas metroplex for July, with details TBA soon.  A convenient location for those attending is being sought since this is a large metroplex, price and program length will remain the same.  Please contact Star10R  at star-10r-dallas@affects.biz or star@affects.biz  for interest in the Dallas or Houston areas.

 His main goal is to get this knowledge out there. On that note, he has made his programs’ cost close to nothing. He only charges $350 per individual or only $3000 a community to train 10 Cargivers ($300 per community caregiver). Please let me know if you can make this training and feel free to pass this along. This training is also a great marketing tool for communities to differentiate themselves, while reducing cost with no overhead or risks for that matter.  Remember, this does provide 8 CEUs for this class if you attend the entire day.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Lung Disease Management Conference


It is my pleasure to announce the 2 day course June 22-23, in fabulous Las Vegas, offered by Lung Center University.  If you are a health care provider that cares for patients with Lung Disease, you will not want to miss this conference.  Learn about the changes made in 2010 to Pulmonary Rehabilitation guidelines.  This program showcases the latest therapies and treatment options for patients suffering from chronic lung disorders.  You will learn how to manage costs better, improve quality of care, and grow your disease management program.  This was created for skilled nursing facilities, home health, and outpatient facilities to discuss hospital to home solutions for these chronically ill patients.

Read more and register at  Lung Center University  Please contact Lung Center University direct for any questions and information.

Speakers include Greg Shockey, President of America, Mel Arenas, RT & Sr. VP of Lung Centers of America, Jim Girard is the National Sales Manager for Schiller-America and Jan Jennings, President & CEO of American Healthcare Solutions.  This team of speakers has a very well documented and prestigious career in the health care industry.  You can read the extensive biography on each speaker under the agenda.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

HITECH Compliance & Implementation Tips Happy Hour


Starts: Wednesday October 27, 2010, 05:30PM CDT
Ends: Wednesday October 27, 2010, 07:00PM CDT
Event Type: Conference
Location: BlackFinn
4440 Beltline Rd
Addison, TX  US
Intended for: Physicians, Office Managers, Information Technology Managers, Privacy Officers, Health Care Attorneys, Owners, Upper Management, Senior Level Management
Industry: hospital, physician, dental, pharmacy, DME, home health care
RSVP: kpearson@marjencapital.com or angela@medicalauditingsolutions.com
Organization: Marjen Technology Group & Medical Auditing Solutions LLC

This event is exclusively for health care providers and health care attorneys due to the content of the program. Please RSVP as seating is limited to 35.

HIPAA HITECH Happy Hour Drink Coupons & Appetizers Provided

We will provide a short presentation on new HITECH HIPAA highlights 6:00pm-6:30pm allowing time for Q&A

Topics:  Meaningful Use, What is Encrypted, and Tips to encryption without breaking the bank

Speakers:   Karen Pearson & Raj Croager Marjen Technology Group

Angela Miller Medical Auditing Solutions LLC

There will be prizes worth showing up for such as a new WatchGuard firewall that protects PHI before it leaves and Consulting Certificates.

MARJEN Technology Group is a privately held technology services company located in Arlington, Texas, bringing over two decades of experience to Dallas/Fort Worth area businesses.  Our mission is to bring enterprise class technology and services, at affordable prices, to small and medium size businesses.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Office Manager Job


I have a ENT in southeast Texas (Golden Triangle) that is looking for an office manager. This office services patients from Orange, Beaumont, Lumberton, Port Arthur and surrounding towns. It is a solo practice that sees patients in the office and performs surgery. Person does need health care billing and management experience. Billing is currently outsourced. The person needs to be a good leader as there are 3 other staff members in the office. The salary is $18/hr and at the moment no health benefits. Please forward resumes to fax 214-461-0295 or email medaudsolutions@aol.com

Patient Visits: Changes, Increase Revenue, & Ordered Services


“15 MINUTE THOUGHT”

New Patient Visit Requirements: Increase Your Revenue

MAS is pioneering an informational program that you can listen to over a cup of coffee while you organize your day or on your drive to work. The name of the program is “15 Minute Thought”.  These calls will be free and informative.  Our focus is to give you a new thought once per month to help improve your business during these tough regulatory times.  The call participation should be maintained although CME/CEUs are not attached, it documentation of education efforts.

We will discuss health care reform changes that impact the requirements for patient visits, date last seen, and chart documentation.  We will discuss how to make lemonade out these lemons!  We need to cease the opportunity to increase revenues out of these changes.  Spend 15 minutes and learn about changes that can stop your payments as well as how to increase your revenue.

Program your Phone and Calendar:

The 2nd* and 3rd Wednesday Every Month

July 21, 2010  at 8:30am-8:45am CST

Speaker:          Angela Miller, CHC, Compliance & Billing Expert & Edward Vishnevetsky of Thompson Coe

MAS Conference Call Dial-in#:         218-862-1300

Conference Code:                               622911

MAS Office number:                          972-459-1508

Who should call in?

All health care provider, Health care business owner or manager, Physicians, Home Health, DME, HME, Attorneys, Compliance Officer, and Office Managers

Follow MAS Blog for Schedule & Updates.  You can “follow” MAS on all social media and new blog links are published.  We only publish useful information and breaking news.

Blog:  http://www.angelamillermas.wordpress.com or via website
Linkedin:  http://www.linkedin.com/in/medicalauditingsolutions
Facebook:  http://www.facebook.com/home.php#!/AngelaMiller.MAS

Edward L. Vishnevetsky has extensive experience in the area of health law and commercial litigation. He routinely argues before state and federal courts in areas of health law, employment law, and complex commercial litigation, and also represents hospitals, physicians, durable medical equipment (DME) providers and manufacturers before various state and federal regulatory agencies. Edward advises health care clients on operational matters, liability exposure, privacy issues, federal and state health care regulatory compliance, health care reimbursement disputes, as well as risk management issues. He has represented individuals, physician groups, hospitals, ambulatory surgery centers, sleep laboratories, dialysis clinics, independent diagnostic testing facilities, and DME suppliers.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria through compliance program development, management and training.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Numerous Physician, Physician Groups, and DME Revocations Coming


The American Health Lawyers listserv released yesterday, there are numerous revocations across physician, physician groups, and DME providers for failure to respond to 855 validation or update requests or the provider was not open or available during a sight visit.  Please ensure you or your staff open mail in a timely manner!  Be sure you take immediate action on any requests from Medicare.  Medicare periodically requests for updates, validation or new 855 payor applications be completed. If the Medicare contractor does a sight visit, you must have hours posted and the door must be unlocked and the person greeted, if it is during your business hours.   Likewise, if you are closed for vacation, post a sign on the door & answering service vacation dates and who patients should see in an emergency.  This may have come as a PECOS notice.  Think of PECOS as your online 855 submission and application management.  Educate your staff to review mail timely and notify you immediately of any requests from Medicare for any response, forms, documentation.  You as the business owner need to review it or have it reviewed.

It seems every time  we turn around there is bad news to deliver to health care providers.  This is a very scary time from audits, revocations, reimbursement cuts along with legible documentation and getting patients to come into the office for an in-person visit when they are physically not capable.  The industry is facing challenges.

Medicare must be notified if you move because they mail requests to the address on file.  Remember, an invalid telephone number or area code can result in revocation as well.  Likewise, the post office does not always deliver the mail and they do not send communication with a tracking number!

You have 30 days to submit a corrective action plan, but be proactive and do it immediately!  The Corrective Action Plan form can be located via the MAC contractor website.  If the Correction Action Plan is denied, there is no appeal!

It is crucial for you to keep your provider number because without it you will not be reimbursed and are subject to loosing other payor contracts. You have to get your number placed in good standing, but this can be a long process.  They also do not have to activate it back to the date it was turned off.  If you need help completing or validating the 855 application or working an appeal, we can help you in a cost effective manner.   We work with several health care law firms that can assist you also.  Be sure no matter who you have help you, they have experience with the application process, understand the health care industry and/or are health care attorneys.

I feel like I need to have a drink or joke of the week blog so I can bring some good uplifting news.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Medicare Timely Filing Reduced to 12 Months


As you may recall in my earlier health reform blog,  I noted that one of the several changes to be implemented was the reduction of the initial claims filing period reduced from 18 months to 12 months.  I would encourage you to read the other operational changes impacting collections noted in the blog.

Region A MAC and HCCA Compliance Weekly published the system change on May 14.  Each contractor may have a different published date but it appears that the announcements will be coming very shortly.

Note the change is RETROACTIVE to all claims on or after January 1, 2010! This would indicate that CMS has most likely directed all contractors to this announcement.  Notify your billing staff ASAP, they only have 1 year to file an initial claim.  For providers who must receive documentation from physician’s prior to billing, you must be more diligent than ever before.  If the physician’s are not providing the necessary information to bill for the services ordered, get the patient involved.  The patient can request a copy of their record at any time and can carry the order to the physician for signature.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest private held HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.

Health Care Reform: Compliance Programs, Reduce Filing Limits, Limited Ownership


The Health Care and Education Reconciliation Act of 2010 signed March 23, 2010, has made significant changes to health care providers and claims filing requirements.  Remember, CMS will have to publish written notification and post implementation deadlines; however, it will make your life easier to start educating staff and changing practice now.

*  Mandatory Effective Compliance Program for ALL health care providers that bill Medicare, Medicaid, and other federally funded program from hospital to mental health and everyone in between.

A compliance program has been required for providers collecting $5 million or more per year in Medicaid funds collectively since 2006.

http://www.cms.gov/smdl/downloads/SMD121306.pdf

New York Office of Inspector General implemented state requirement for effective compliance program 10/1/2009. http://www.omig.state.ny.us/data/content/view/79/1/

An effective compliance program contains 7 elements which includes Compliance Officer, Compliance Committee, Code of Conduct (approx 70 pages), Policies & Procedures (50+ depending on practice), Minimum of 5 hours of training per year on specific relationship and billing topics, Auditing and Monitoring Function, Reporting Options without fear of retaliation, and a few others that are embedded in these items.  It takes at least 12 months to roll out a compliance program and about 18 months to see effectiveness.  As a note, accreditation policies typically do not include most of the elements likewise the audits typically are not coverage criteria based or risk based.

*  Physicians must have a Face to Face with patients prior to ordering DME (durable medical equipment) and HHA (Home Health) Services effective 2/23/10.  This should be taking place now; however, if not, do not wait until CMS publishes an effective date.  This is good business practice and should be implemented immediately.

*  Physicians must be a Medicare provider as of July 1 2010, if they order DME and HHA that will be billed for Medicare reimbursement.

*  Physicians must provider medical record documentation to support referral orders or be subject to a revoked Medicare supplier number for a period not greater than one year **ADDED**

*  Claim submission filing limit has been reduce from 18 months to 12 months.  Until CMS publishes an effective date, you will have 18 months.  Be on the look out.  Announced 5/14/2010

*  Expanded Stark Law regulations will limit physician ownership in hospitals as of 12/31/2010.

*  Must provide patient choice when you have diagnostic equipment in your office such as MRI, PET, CAT.

*  Stark & Anti-kickback violations will also receive penalties until Federal False Claims Act.

*  Overpayments must be refunded to Medicare/Medicaid within 60 days whether you identify the overpayments or the refund is requested.  Failure to do so is likely to result in a revoked provider number and sanction from participating with the Medicare and Medicaid programs.  This was actually part of the Patient Affordable Care Act.  CMS announced 10/15/2010 see also Cynthia Stamer’s Blog.  This announcement also has language on Self Disclosure of Self Referral practices that have taken place.

*  Have heard from several people, that Oxygen will be reduced from 36 months to 13 months.  However, I have searched the full text and amendment and cannot find it. **ADDED**

*  It will require insurance payers to reimburse preventative services at 100% with no co-pay.  Please note, this has not been published with an implementation date so continue to file claims as normal.  Patients cannot expect to receive free preventative services until their payer publishes this change!

*  It appears to me that only companies with 50 or more employees will be required to provide health insurance for all W-2 employees.  I will be interested in seeing how this turns out.   It also appears that in 2018, you will have to use the government health care program or loose tax credits of 25-35% of the premiums.  I wish I had one of this money trees in my back yard!

This covers many of the highlights that impact provider billing, but there are so many more points.  Read over the information so your are prepared.  If you find you need your compliance program reviewed and developed remember to find a consultant that focuses on ALL aspects of compliance not just a compliance program.  They need to understand billing and operations and we are one of the companies that offers an all encompassing solution to health care providers.

You can reference the full text http://www.cbsnews.com/htdocs/pdf/Senate_health_care_bill.pdf and amendments http://www.cbsnews.com/htdocs/pdf/House_reconciliation_package_031810.pdf as well as a blog from Looper, Reed, & McGraw http://www.lrmlaw.com/pdf/ALERT-Healthcare-Reform-Alert.pdf.  Search the document for key words used in bullet points.  I have also included a Timeline link that has many items bullet pointed except the ones that apply to providers and reimbursement for Medicare services http://docs.house.gov/energycommerce/TIMELINE.pdf

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller has made it the  focus of the business to help providers run their businesses efficiently, collect money, and maintain compliance with federal and state regulations and coverage criteria.  Ms. Miller is very experienced with Medicare & Payer audits.  Ms. Miller ran a very successful compliance program for over 5 years for the largest HME/Pharmacy provider in the US at the time.  Ms. Miller  also works as a contract compliance officer to provide an avenue to compliance training to staff, implementation of policies, as well as handling anything that affects cash flow from the initial intake to back-end collections. You can visit our website at Medical Auditing Solutions LLC.