NJBIZ’s Post

Discover the incredible journey of the "Prudent Layperson Standard" (PLP) and its pivotal role in safeguarding patient access to emergency medical services. From Maryland's groundbreaking enactment in '93 to recent legal battles challenging the PLP, this article explores the past, present, and future of this crucial healthcare protection. Read more about the resilience of the PLP in this essential piece on emergency medicine and patient care. Written by Dr. Todd Parker, MD, FACEP and Zotec Partners own Ed Gaines, JD, and Elise Boessler. https://bit.ly/3SiWvGC #HealthcareAdvocacy #EmergencyMedicine #PatientProtection #RobertsDecision #PLPStandard

When was the last time you audited your incident-to billing? One Michigan health system found out about its noncompliance the hard way: An OIG settlement of $671,310. #oig #falseclaimsact #incidentto #medicalcoding #medicalbilling #ideacentrehimsolutions Link:

When was the last time you audited your incident-to billing? One Michigan health system found out about its noncompliance the hard way: An OIG settlement of $671,310. #oig #falseclaimsact #incidentto #medicalcoding #medicalbilling #ideacentrehimsolutions Link:

This year at the RISE conference in Colorado Springs, OIG's Inspector General Christi Grimm spoke on the risks of persistent healthcare fraud and its affects on Medicare Advantage. Is your facility's credentialing in order? Are your processes sustainable? You can read or watch the full presentation here ⬇ https://lnkd.in/gqWnMsDp #Medicare #MedicareAdvantage #HealthcareFraud #Compliance #OIG

This year’s appeal season has been non-stop. I enjoy it. Recently, I reviewed an appeal I thought would be upheld as the information reviewed did not quite meet the National Coverage Determination (NCD) I consulted with the physician, who felt it could be overturned. But. We just didn’t have the information to support it. The physician reached out to me to retrieve additional records. I called and received the generic, please fax your request in writing, and it will be addressed in 48+ hours. Days passed, and there was no response from the provider. No new information was received. I reached out again as the physician was waiting on the new information. No response. The physician requested we reach out again. On my last attempt at communicating with the provider, I was able to speak with someone, willing to assist right away. I explained exactly what was needed. It took some digging on the provider’s part as what was requested was not usually included in the office notes/progress notes. In the last hour, the information was received. The physician confirmed the medical history and reviewed prior procedure notes/operative reports to establish medical necessity. There are plans out there, yes Medicare Advantage plans, doing what is best for the patient. Thanks, doc, and much respect! #healthinsurance #utilizationmanagement #appeals #denialsmangement #patientadvocate #ACA #ERISA #priorauthorization #healthcarereimbursement #medicareadvantage #cms #healthcarelaw #medicalnecessity #legalnurse #legalnurseconsultant

Fascinating points to ponder ..

Solicitations come in all forms from many areas during Medicare Annual Enrollment. It's important to filter thru those and work with a local licensed professional. Randall Garcia of Medicare Pro explains in this KSAT SA Live segment. https://lnkd.in/dyDh6AtH #medicare #medicareaep #medicareannualenrollment #medicarecoverage #medicareinsurance #medicaresanantonio #texasmedicare #medicarespecialist https://lnkd.in/gGUF3eR7

Posting an important update on last week's U.S. 5th Circuit Court of Appeals ruling regarding "no out-of-pocket cost" preventive care services under the ACA. Zero dollar coverage stays in place, but the case is remanded back to the Federal judge who threw out these zero dollar coverages in the first place. In remanding the case back to the district court, the 5th Circuit has set a course for much still to come in this dispute; further arguments in the district court, and likely further appeals to both the 5th Circuit and the U.S. Supreme Court. And, not to be overlooked, the outcome of the U.S. Presidential election all will undoubtedly determine the fate of zero dollar preventive health services for millions of Americans. Learn more about this recent decision and its implications. #HealthLaw #ACA #PreventiveServices #ZeroDollarCosts

The American Hospital Association strongly opposes cutting $1 billion from Medicare funds for hospitals that serve low-income and uninsured patients. They believe this could harm these hospitals and the care they provide to vulnerable groups. #AHA #MedicareCuts #HealthcareConcerns #HospitalFunding #PatientCare #HealthcareAccess #VulnerablePopulations #UninsuredPatients #HealthcareAdvocacy #medicare #cms https://lnkd.in/gMZ2FUNF

Solicitations come in all forms from many areas during Medicare Annual Enrollment. It's important to filter thru those and work with a local licensed professional. Randall Garcia of Medicare Pro explains in this KSAT SA Live segment. https://lnkd.in/gXmJ5szg #medicare #medicareaep #medicareannualenrollment #medicarecoverage #medicareinsurance #medicaresanantonio #texasmedicare #medicarespecialist https://lnkd.in/g_XWNWPE