Comments for ZPIC Audits ■ Medicare Audits

Comment on MIC and MFCU Dental Audits On the Rise by rliles

rliles — Mon, 30 Jul 2012 18:13:14 +0000

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Comment on MIC and MFCU Dental Audits On the Rise by Dentist in Louisville KY

Dentist in Louisville KY — Thu, 19 Jul 2012 05:39:04 +0000

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Comment on 5 Fundamental Medicare Compliance Concepts by rliles

rliles — Wed, 09 May 2012 15:28:15 +0000

Andrea, Thanks for contacting us. We would recommend the Certified Medical Compliance Officer (CMCO) course offered by Practice Management Institute. The link is: http://www.pmimd.com/certify/cmco.asp . This course teaches students a great deal about compliance plans, Medicare audits and enforcement, and other aspects of a medical practice to assist in reducing the likelihood of an audit or other legal issues. In addition, we can also assist your organization in developing and implementing a compliance plan, and training your staff on compliance issues. Call us at (202) 298-8750 for more information.

Comment on 5 Fundamental Medicare Compliance Concepts by Andrea Moore

Andrea Moore — Fri, 27 Apr 2012 19:07:24 +0000

I work for a home Health Agency in Oklahoma, My title is Medical Records/CQI Clerk. I take pride in knowing everything is in it’s place, every I is dotted and t crossed to the best of my knowledge, but i’m mostly self-trained, the office manager and myself. I’m told of Medicare guidelines that just don’t look right, so therefore again I run it to the office manager and we refuse to do things there(other employees)way. We are scared of being audited and we told the owner/administrator, and she is sending us to a QIES workshop, but I would love to know more of Medicare, Medicaid, Zpic guidelines in wound care, plan of care, recerts, coding,etc…If you could help me by directing me to some online classes or documents where I can better do my job and be in compliance with Medicare, Medicaid, Zpic I would very much it.

Comment on 5 Fundamental Medicare Compliance Concepts by rliles

rliles — Fri, 20 Apr 2012 17:45:41 +0000

While it might be more work to write a daily progress note for SNF patients, the fact is that the claims will likely be denied for lack of documentation if there are no daily notes. In our experience with SNF clients, those with accurate daily notes have faired tremendously better in the audit process than those without. While the question of fraud may be a grey area, we believe that CMS and its contractors will most likely find that these types of claims represent an overpayment. When you say electronic billing, does the SNF also use electronic health records?

Comment on 5 Fundamental Medicare Compliance Concepts by M Baker

M Baker — Mon, 16 Apr 2012 21:56:11 +0000

I am a COTA/L under contract with a SNF chain, our building located in WA. Recently, the Dir. of Rehab told the therapists that a daily note is not required. I always write a daily note, but lack of documentation to justify that skilled service was rendered seems to open up a huge area for fraud. This company uses electronic billing, which is e-signed. So without a note in the patient’s chart, how can just a CPT code entered justify that skilled service was actually provided? AND, isn’t it a Medicare requirement that the service is 1:1 – that the billing therapist actually is WITH the patient? This company’s electronic billing system is accessible from anyone’s computer, as long as they have a user name and password. That means one can bill from home, or from an I-phone without even seeing the patient if they choose to. Your thoughts?