OIG Work Plan 2013 – Medical Equipment and Supplies


If you are not aware, every year the OIG ( Office of Inspector General) produces a report on what they plan to audit and review for the upcoming year. The new report does not take past items of interest off the table.

Here are some highlights for medical equipment suppliers:
1. They will review Accreditation Organization and their process for approving providers.
2. Service code modifier KX indicates the patient meets the medical criteria and upon request their is information that supports the medical need of the patient. In audits, they have found that providers have little to no documentation to support medical need. Make sure you read the medical records you obtain from physicians ordering services to ensure they include documentation that supports services you have provided.
3. In audits of lower limb prostheses, they have found in 267 providers audited no history of the patient having a lower limb amputation. I would recommend if you are providing prostheses, you obtain where the amputation was done. Medicare may not have documentation because it was not paid for by Medicare or change of physicians.
4. It appears they will be looking at reimbursement for several items and comparing it to other payor sources to see if they can reduce their reimbursement or frequency for items such as erect aids, back orthoses, parenteral nutrition, and CPAP (frequency).
5. Diabetic supplies will be reviewed for: a) see if medical records corroborate the IDDM as compared to NIDDM (making sure IDDM isn’t submitted just to bill for more supplies), b) multiple supplies, c) make sure supplies are not auto shipped, d) patients requests refill, e) the quantity of supplies left is documented at the time of request for refill, f) compares supplies provided to the competitive bid areas, g) see if “non-mail” order supplies were actually mailed, if they are in competitive bid areas, and h) IF supplies are mailed but KL not applies to indicate so the provider receives a higher rate of reimbursement.

If you have not started your compliance program audit and risk assessment protocol, these are some key areas to look at to reduce your business risk. Ask physicians to provide copies of medical records at the time of the order.

Remember, to look at the OIG Work Plan from 2012.  I outlined hightlights last year that you really need to review if you did not and continue to include those moving forward.

You may find the the OIG Work Plan details at https://oig.hhs.gov/reports-and-publications/workplan/index.asp and see Medicare Part I for Parts A & B.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller is Certified in Healthcare Compliance.  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.

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Accountable Care Expo – Dallas – Medical Auditing Solutions LLC August 1 2012


As many of you know the Patient Protection Accountable Care Act has a mandate requiring the implementation of cost containment managed care of patients, or Accountable Care Organization (ACO).  Many have been sitting on the sidelines waiting for the US Supreme Court Ruling on, and since they upheld ObamaCare….this is moving forward.  So, join Dallas area providers as they collaborate on HOW IN THE HECK to implement programs locally and make it work.  Providers and patients need to take a valid interest in being proactive versus treating the present situation.  You can view the agenda and register for the Dallas Accountable Care Expo to be held August 1, 2012 all day attendance is free except for the luncheon.  If you are not in the Dallas area, there are ACO Expos planned for Chicago and Las Vegas with others in the works.

Angela Miller, President of Medical Auditing Solutions LLC will be speaking on the Compliance Program Requirement.  All participants in an ACO must have a compliance program in place to participate so before March 2013.  Ms. Miller has over 18 years experience in corporate compliance programs, healthcare billing, collections, and coding audits.

Edward Vishnevetsky, Healthcare attorney with Munsch Hardt will be the luncheon Keynote Speaker on “Obstacles with ACO.”  Have you ever been able to listen to an attorney for the cost of lunch?  Well, mark this on your calendar and register now.  Mr. Vishnevetsky will also be speaking on the implications of the US Supreme Court Decision to uphold ObamaCare.

Bring your questions, concerns, and ideas on August 1, 2012.  It will be a day of speakers and exhibitor booths.

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller is Certified in Healthcare Compliance.  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.

Webinar on What is a Compliance Program 101!


Medical Auditing Solutions is providing a webinar in conjunction with The Cornerstone Insurance Group (Cornerstone) to discuss the Basic Compliance Program Requirements.  We will learn what a compliance program is, what laws require it, the elements of a compliance program, and how the program can be beneficial to the healthcare provide.

Any and all healthcare providers (medical and dental practices as well as ancillary providers such as DME, Home Health, Hospice, etc.) taking Medicare and Medicaid should attend.

No CEU credit is formally given, but you will be welcome to send the handout received post attendance to your accrediting agency and ask for credit.  Some will provide and the worse they can do is say no.

The Cornerstone Insurance Group (Cornerstone) in no way endorses the accuracy of the information being provided.  In registering for this program, you will release and hold Cornerstone harmless of any and all actions you take as a result of this call.  This call is basic information and is simply an avenue for you to educate yourself on compliance program requirements.  This call in no way provides legal advice or provider specific advice without adequate documentation to review.  This is informational purposes only.

Cornerstone providers Total HR management & products including benefits management, Total Insurance products, Wellness Management Services.  Read more about the services Cornerstone offers you may find services that could benefit your organization.  They are primarily in Missouri and surrounding states but do cover additional states.

Program Title:  Compliance Program Basics and Elements

Date:                     July 24, 2012

Time:                    11:30 am-12:30 am CST

Cost:                      Complimentary

Register:              https://cc.readytalk.com/r/yhypbz3hj2p

About more about the speaker and Medical Auditing Solutions LLC:

Angela Miller of Medical Auditing Solutions LLC has been in health care compliance, auditing, billing, collections and HIPAA for over 18 years.  Ms. Miller is Certified in Healthcare Compliance.  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.

AAOE – Developing Effective Elements of a Compliance Program Webinar


Angela Miller, CHC and President of Medical Auditing Solutions LCC will be discussing the reason you must have a compliance program, the deadline, and the elements of an effective compliance program.  We will discuss how to make these elements effective.  After the Supreme Court Ruling on Thursday, we know PPACA is here to stay so let’s get started with the compliance program development and it can improve your overall business.

This program was offered at the national AAOE meeting in New Orleans in May 2012; however, due to a funeral I had to cut the program short.  It has take a little bit of time to get this setup, but we are ready to make this available by webinar and will still have 1 hr AAPC credit.  Also keep in mind, you can ask other credentialing organizations if they will consider CEUs for the certification you have.  You will need proof of registration & attendence, this printed out with the learning objectives, and possibly the course material (which may be the materials since they will not be posted on AAOE’s website).  They can only say No.  If you registered for the New Orleans conference, please mention that as there will be no charge to my understanding.  For those of you interested that are not AAOE members or did not attend the Annual Conference, you may still purchase the attendance below.

Please contact AAOE direct about registration at Register Now

This program will be about 1.5 hours in length.

Mark your calendars for the AAOE’s upcoming Webinars:

  • July 10, 11:00am–noon Central time: The Technical Side of the ICD-10 Conversion – The Untold Story sponsored by AAOE and Coker Group  
  • July 19, 11:00am-12:30pm Central time: Developing Effective Elements of a Compliance Program sponsored by AAOE
  • August 1, 11:00am–noon Central time: Improving Efficiency in the Office Setting sponsored by AAOE and TransPortal

 Save the date for the 44th Annual Conference in San Diego, CA: April 28-30, 2013

About the speaker:

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.

Physicians: Added Revenue for Assessments like Depression, ADD, BiPolar


Several months ago I met a representative from AssessMD.  I have observed and asked many questions.  AssessMD is a computer software that collects answers to questionnaires for assessments many physicians are doing manually now and not being reimbursed because the assessment is not scored.  AssessMD has assessments to score depression, bipolar, ADD, Anxiety, OCD, ODD,  and others with more test coming.  The patient completes the assessment in a few minutes on the physician’s computer or tablet, and produces scored results for the physician in real time.  The physician can then bill for this assessment in addition to the Evaluation and Management Code (E&M) with the documentation provided by this computerized assessment.

Medicare is now requiring annually assessment for depression among the elderly patients.

This is reimbursed by most insurance companies except certain Medicaid.  The reimburse on average is about $60, which would go direct to the physician’s bottom-line because right now if it is handwritten assessment it is not reimbursed.

The physician has a 45 day trial period to test it in his practice.   If you are not reimbursed by the insurance company, there is no charge of the test to the provider.  As a note, AssessMd is not in a position to be a referral stream only a vendor.

This was initially marketed to limited physician practice types, but they have discovered that it is beneficial to many practice areas pain management, obstetrics/gynecology, elder care, and adolescents to name a few.

At the very least it is worth the time to investigate and discuss with your legal counsel to add revenue to the practice.  If you do not have healthcare counsel, click for a list of affordable healthcare attorneys to ensure this is the right model for your practice.

Contact LouAnn McNaughton  at  “214*538*1123”  or   “LouAnn@assessMD.com”

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.

Humane Healing: 1 Fantastic Wound Care Product


We deal with human healthcare issues everyday, but I wanted to share information on a product I have found because I know many of my followers and friends have pets.  We all know our animals play and get cuts and scrapes which can manifest into hard to heal wounds.

Humane Healing Wound Care is an incredible product for all your fury friends/family that injure themselves, fight with other further animals, or these manifest easily into larger harder to heal wounds.  I started using the salve, it does require you to apply and rub in but the healing can be detected as early as the second application.  I used this on one dog’s spay incision and the vet could have taken the stitches out around day 5 or 6.  This same dog gets cuts and scrapes including those that tear the skin back (yuck)…just a few days of ointment application and the wound is gone. The latest product is a spray that you don’t have to rub in which is fantastic for the animal with wounds sensitive to touch or the animal that is a big baby and whines before you ever touch them.  I have even used it on myself since I am so Graceful….and it works just as well on human skin with visible improvement sometimes with one application, although it is not sold nor marketed for human use.

This product works so well because it reduces the inflammation which is what cause the dogs (pets) to lick the wound, as I have been told.  If the inflammation is reduced, the wound won’t itch as much so the pet won’t pay as much attention to it.

If you have been to a vet lately, you know they hold you hostage on products that cost a fortune and many times it is because they have marked the product up 50-100%.  This helps you SAVE MONEY and avoid the vet.  This product is very affordable and the results are fantastic. A small amount goes a long way in this product which is why they sell this is smaller quantities and then hopefully it doesn’t expire before you use it all.

Check out the product if you have an animal that is prone to injuries and/or injuries turn into hard to heal wounds.

Humane Healing

http://www.humanehealing.com/

Phone: 888.246.3155

Fax: 888.787.8872

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.

Medicare PrePay Audit for Oxygen and CPAPs for all MACs


As I understand it, all Oxygen and CPAPs in all Medicare MAC regions are on prepayment status.  This means you will be getting additional documentation or development request letters to provide documentation to support medical need prior to the claims being paid.  This evidently is being discussed in Mac Council Meetings this month.

How to do improve turnaround time?

You need to obtain all documentation, physician chart notes, date last seen initial and renewal (if applicable), and copies of test results at the time of the order intake and certainly PRIOR TO BILLING.  Waiting until the request is received puts your business in danger of missing the deadline due to the physician failing to see the importance of a timely response to the request for records.

What is your plan?

Have you diversified your business model with higher ratio of commercial payers?  If not and you want to increase to likelihood of sustaining prepayment audit while Medicare penalizes everyone in the industry with this prepayment plan you need to look at diversification.

If you have better ideas for fighting fraud and abuse beside penalizing everyone in the industry with prepayment audits, the Senate Finance Committee is seeking input from the healthcare community.  Speak up!

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.