Investigators have long considered Home Health claims to be rife with the potential for fraud. The daily news illustrates this point as fraud convictions of Home Health operators appear regularly. Last week, an owner of a Miami Home Health company pleaded guilty to a $13 million fraud, perpetuated by kickbacks and bribes to patients and medical providers for referrals and prescriptions that were used to fraudulently bill Medicare . 1 Data indicating fraud in home health claims has important imp ...

Most healthcare professionals - from vendors to coders to physicians - are concerned about one aspect of the upcoming, mandated transition to the ICD-10 code set slated for October 1, 2015. A growing consensus across the healthcare industry is that the commonly used General Equivalence Mappings (GEMs ) files, published by the Centers for Medicare & Medicaid Services (CMS), are not enough to ensure accurate and appropriate results between ICD-9 and ICD-10 codes. Both in forward and reverse m ...

The U.S. House Energy and Commerce Committee ’s subcommittee on healthcare is holding a hearing on ICD-10 implementations today, Wednesday, February 11, 2015. The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), titled this meeting, “Examining ICD-10 Implementation” and subcommittee members will hear from a number of ICD-10 stakeholders. This subcommittee has been working with the Centers for Medicare and Medicaid Services ( CMS ) for several months to ensure this de ...

The U.S. House Energy and Commerce Committee ’s subcommittee on healthcare will hold a hearing on ICD-10 implementations on Wednesday, February 11, 2015. The Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), titled this meeting, “Examining ICD-10 Implementation” and subcommittee members will hear from a number of ICD-10 stakeholders. This subcommittee has been working with the Centers for Medicare and Medicaid Services ( CMS ) for several months to ensure this deadlin ...

Payers should pay particular attention to physician claims utilizing modifier 25 because this modifier is commonly misused and results in a high claim denial rate. The technical definition for modifier 25 is a significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. This modifier is used on the Evaluation and Management (E/M) code when there are other services perfo ...