Tag: claim
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What Have You Done for Me Lately?
“What have the Medical Association and ALAPAC done for me lately?” It’s a question posed to me often, in various forms, by physicians whom I’m asking to join the Medical Association and contribute to ALAPAC. It’s a tough one to reply to – not for a shortage of answers – but for the difficulty, even…
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Fewer Physicians Could Be Audited under a New CMS Program
Fewer physicians will undergo audits under a new Medicare claims review process, according to a Centers for Medicare & Medicaid Services announcement. CMS will roll out a new approach to claims review nationwide targeting fewer providers and requiring review of fewer claims. The new policy, to take effect later this year, makes it less likely…
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Have You Properly Obtained Informed Consent?
In June, the Pennsylvania Supreme Court issued a controversial opinion holding that a physician had to have face-to-face interaction with the patient to effectively obtain informed consent. This has raised heightened awareness of a physician’s obligations to obtain informed consent from their patients and caused many to evaluate their own practice of obtaining informed consent.…
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A Refresher in the Medicare Claims Appeals Process…
With the increased audit activity we are seeing among the alphabet soup of Medicare contractors – RACs, ZPICs, SMRCs, CERTs, etc. – now appears to be a good time for a refresher on the Medicare claims appeals process. Due to this increased audit activity, more and more claims are being denied, both under pre-payment review…
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What is the ProAssurance Legal Defense Endorsement?
As a ProAssurance insured, did you know that in addition to medical professional liability coverage your ProAssurance insurance policy also has embedded legal expense coverage for a variety of regulatory risk exposures, certain types of disciplinary proceedings, and other types of covered investigations? It’s called the Legal Defense Endorsement, and it is an automatic part…
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Close Patient Care/Diagnosis Gaps with New Informational Claim Process
Blue Cross and Blue Shield of Alabama now offers a new informational claim process in which you have the option to submit an informational claim through ProviderAccesseClaims to report previously closed patient care/diagnosis gaps. The informational claim is for reporting purposes only. Effective March 6, 2017, the option to dispute an item on a patient’s…