Billing company compliance program guidelines published by OIG.
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Fraud↗
Biomedical subjects
A B Wachler
Publications and source records attributed to A B Wachler.
Stark reality. How Stark I and II will impact physician relationships.
On August 14, 1995, the Health Care Financing Administration (HCFA) published a long-awaited final rule implementing the Ethics in Patient Referrals Act (Stark I). In conjunction with this final rule, HCFA intends to survey hospitals and physicians to obtain information necessary to evaluate compliance with the Omnibus Budget Reconciliation Act of 1993 amendments to the Stark Act (Stark II), most of which took effect on January 1, 1995.
Centers for Medicare and Medicaid Services, U.S.↗
Rules' complexity increases. New physician incentive regulations described.
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Capitation Fee↗
Handle with care. Avoiding the perils of the RFP process.
Beginning a year ago, with the issuance of the first RFP to service recipients in five southeast Michigan counties, Michigan has sought to control the rising cost of providing health care services to Medicaid recipients through the use of managed care contracting.
Competitive Bidding↗
Stark II proposed regulations. Impacting group practices and physician employers.
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Centers for Medicare and Medicaid Services, U.S.↗
New guidelines in place.
On Dec. 1, 1998, the Office of the Inspector General (OIG) of the Department of Health and Human Services published its Compliance Program Guidance for Third-Party Medical Billing Companies to assist companies in the development of compliance programs to promote adherence to applicable laws.
Fraud↗
Phase I of the Stark II final rule.
On Jan. 4, the Health Care Financing Administration (HCFA) issued final regulations implementing the Stark II ban on physician self-referral. These final regulations, which go into effect Jan. 4, 2002, are described as "Phase I" since they address only a portion of the Stark law. HCFA promises that additional final regulations implementing the remaining portions of the Stark II ban will be published at a future date. This article provides a brief overview of the highlights of the Phase I final regulations.
Centers for Medicare and Medicaid Services, U.S.↗
Setting the standard.
Beginning Oct. 16, 2002, hospitals will no longer be able to submit claims to third party payers electronically unless the claims are in standard format. As a result, claims formerly submitted in UB92 (currently the defacto institutional claims standard) or other traditional formats will need to be submitted in X12N 837, which is a standard developed by the Accredited Standards Committee of the American National Standards Institute. This requirement is yet another challenge for hospitals resulting from the Health Insurance Portability and Accountability Act (HIPAA).
Computer Communication Networks↗