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KICKBACKS

OIG issues fraud alert on pharmaceutical company in-person speaker programs

Before the pandemic put the chill on live conference events, it was fairly common for pharmaceutical companies, device makers and diagnostics companies to offer healthcare professionals fees for in-person speaking appearances. Such practices raise red flags under the federal Anti-Kickback Statute (AKS) when those speakers recommend the products of those companies to their patients. So, on Nov. 16, the OIG issued a Special Fraud Alert warning companies about restarting in-person paid healthcare professional speaker programs when COVID-19 restrictions lift. OIG Skepticism of Speaker Fees Program Federal government suspicion of paid speaker programs, especially by pharmaceutical companies, is nothing new. For example, Novartis recently agreed to pay $678 million to settle a seven-year-long legal battle with the OIG over allegations of using its speaker programs as a way to disguise bribes to… . . . read more.

AUTOMATIC PAYMENT

Clinicians in three disaster-struck states get MIPS break

If your medical practice is located within the disaster-struck states of Louisiana, California or Oregon you may be eligible for a payment adjustment. In response to the Federal Emergency Management Agency (FEMA) designation of Hurricane Laura and the California and Oregon wildfires as national disasters, CMS has determined that the automatic extreme and uncontrollable circumstances policy will be applied to Merit-based Incentive Payment System (MIPS) eligible clinicians in FEMA-identified areas under sections PA-A and PA-B in Louisiana,  California, and Oregon. MIPS eligible clinicians in these areas in 2020 will be automatically identified and receive a neutral payment adjustment for the 2022 MIPS payment year. During the data submission period for the 2020 performance year (Jan. 4, 2021 to March 31, 2021), all four performance categories for these clinicians will be weighted at… . . . read more.

CODING

Impact of 2021 evaluation and management coding changes to WRVU based physician compensation

By John McDaniel bio As you may know, all physician contracts which include any form of WRVU based compensation will need to be reviewed and probably amended due to the increase in WRVUs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. We recently conducted an assessment for one of our hospital clients which showed the ʺunintended consequencesʺ of increased compensation to the physicians/providers and the resultant impact to fair market value standards. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased reimbursement since the WRVUʹs for these codes have increased. Indeed, the increase in the WRVU component will certainly affect physician compensation… . . . read more.

CMS

Physician Compare Preview Period open until Aug. 20

The Physician Compare 60-day Preview Period is officially open as of June 22. You can now preview your 2018 Quality Payment Program performance information before it will appear on Physician Compare profile pages and in the Downloadable Database. You can access the secured Preview through the Quality Payment Program website. Access the resource below on how to preview your data: · Physician Compare Preview Period User Guide For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov. To learn more about the 2018 Quality Payment Program performance information that is available for preview as well as the 2017 clinician utilization data that will be added to the Downloadable Database, download these documents from the Physician Compare Initiative page: · Clinician Performance… . . . read more.

NEW TRIALS ANNOUNCED

Physicians can report COVID-19 clinical trial data through QPP

Improved availability of data key to driving improvement in patient care and development of innovative practices The Centers for Medicare & Medicaid Services (CMS) is encouraging clinicians who participate in the Quality Payment Program (QPP), such as physicians, physician assistants, nurse practitioners, and others, to contribute to scientific research and evidence to fight the Coronavirus Disease 2019 (COVID-19) pandemic. Clinicians may now earn credit in the Merit-based Incentive Payment System (MIPS), a performance-based track of QPP that incentivizes quality and value, for participation in a clinical trial and reporting clinical information by attesting to the new COVID-19 Clinical Trials improvement activity. This action will provide vital data to help drive improvement in patient care and develop innovative best practices to manage the spread of COVID-19 within communities. “The best scientific and… . . . read more.

BLOG

How to assess the overall health of your medical practice

By Nick Hernandez  bio
How do you know that your overall business is healthy? How do you know that the business processes you perform are…


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WORKING WITH PHYSICIANS

How to handle the ‘bully doctor’ without losing your temper or your job

A growing concern in all types of professional offices is the bully boss. “Bullying is the issue for this decade that sexual harassment was in the…


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MANAGING STAFF

The plain and practical side of medical office managing

Equally as important as regulations, revenue, coding, and Medicare are the day-to-day issues of running the office and managing the…


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COLLECTIONS

Why you need an office policy on collecting fees

Most medical practices take time once a year to create new office goals or a business plan and, hopefully, to upgrade their policy manuals…


. . . read more

BLOG

5 essential steps to ensure an effective HIPAA program

By Danika Brinda  bio
HIPAA Compliance is a term that is often thrown around the healthcare industry; however, I commonly ask myself: Is the meaning of HIPAA Compliance the same throughout the…


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