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05/12/2025
The recent closure of a major practice in Rhode Island, and the efforts of a separate practice to pick up their patients, raises the question: Is it out of line to actively solicit another provider’s patients?
05/12/2025
Physician-owned hospitals must conform to strict rules under Medicare, but a recent advisory opinion (AO) from CMS suggests a way they can expand their offerings without losing their status.
05/12/2025
Since 1976, the Office of Inspector General (OIG) has served as a compliance watchdog, overlooking all HHS programs and monitoring for instances of fraud, waste and abuse. While health care organizations can wait to investigate potential compliance issues until they receive an audit request or gain access to audit findings, you’re better off taking a proactive approach. One important step is monitoring for additions to the OIG Work Plan.
05/12/2025
Medicare utilization of many CPT codes, such as outpatient E/M codes, took a beating in the pandemic years. But use of the critical care code 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and add-on code 99292 ( … ; each additional 30 minutes) jumped higher during that period.
05/05/2025
Vacation season is about to begin. As more physicians head off for a summer break, practices increasingly will report the services of a substitute provider. But whether a physician will be out of the office for vacation, sick leave, maternity leave, paternity leave or any other reason, your practice needs to review the key points for reporting a substitute physician’s — or some physical therapists’ — services.
05/05/2025
The recent HHS announcement of an autism “registry” caused an outcry and a pullback. It also raised the question: How safe is your vulnerable patients’ data when the government demands it, and what can your patients do, and what should they know, if they have concerns?
05/05/2025
You can turn to modifier 25 to help secure complete reimbursement for E/M services, but only when reported appropriately.
05/05/2025
Your final opportunity to respond to the Open Payments data reported against your providers is Thursday, May 15.
05/05/2025
When it is time for physicians to take a break, they are significantly more likely to bring in a fee-for-time provider, formerly known as a locum tenens, than to rely on a reciprocal billing arrangement, according to a review of Medicare Part B claims data from 2013 to 2023.
04/28/2025
A traveling nurse convicted of tampering with morphine raises the question: How responsible is your practice for outside clinical providers hired on a freelance basis?

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