- Making the use of DME and the Medicare Therapeutic Shoe Program easier. Physician Login/Register.
- Healthcare compliance programs billing coding audits cash flow management Dallas, Texas, Kentucky, Tennessee for physicians, dental, DME.
Compliance Program Q& A - Noridian The following questions and answers (Q& A) are cumulative from the Compliance Program web- based training conducted. Some questions have been edited for clarity and answers may have been expanded to provide further details.
Similar questions were combined to eliminate redundancies. Updated October, 2. Q1. How long does Medicare allow for providers to complete and sign off on patient encounters? A1. Providers should complete and sign off on patient encounters within 4.
Q2. Is it appropriate for Provider . If a patient's hospital chart documentation do not indicate the reason for the visit, can it be assumed based on the assessment and plan? A3. Each visit must state the reason for the visit or the patient complaint. Q4. Do critical care notes require a reason for the visit or chief complaint? Or can critical care services be assumed from the assessment and plan?
A4. Critical care notes must identify the reason a provider is seeing the patient. Proper billing is based on what a provider is seeing the patient for and what critical care services were done and not where the patient is situated.
Federal regulations at 42 C.F.R.
DMETRAIN's DME employee training program meets all compliance requirements: a customized online training course providing dme training / hme training.
Learn how the DHHS Office of Inspector General (OIG) provides guidance to various healthcare providers in the form of compliance program guidance documents. The Bureau of Compliance works to educate, assist, and assess Medicaid program providers in meeting their obligation to establish and operate effective.
Q5. Is it appropriate for a hospital to tell an ambulance company that all patients must be brought to their Emergency Room (ER) prior to transporting a patient to a larger hospital? A smaller hospital cannot dictate to an ambulance company that they must bring a patient to their ER for treatment before proceeding on to a larger hospital. An ambulance should take a patient to the closest emergency room or hospital that can render the treatment that the patient needs.
Some patients may require services only available at larger hospitals (for example, major trauma centers). The larger hospitals have ERs that can treat such patients. Q6. Are Compliance Officers required meet a yearly requirement of continuing education and have proof of this on file? A6. No, but continuing education is recommended as regulations change almost daily. Q7. As an option for follow up services for drug and alcohol programs, is it appropriate for an inpatient facility to refer their patients to their outpatient facility? A7. Yes, this is not a violation of any compliance laws.
Q8. Where can providers locate the physician self- referral law on giving patients choice options for lab and x- ray testing?
DME Attorney : : Durable Medical Equipment (DME) Providers : : Durable Medical Equipment Lawyer. Overview. DMEPOS Legal Experience. DME Recent Focus Areas. POS Recent Focus Areas. Outside Resources.
Articles. Speeches. Contact Us. Overview.
The attorneys of Wachler & Associates understand the legal and regulatory areas impacting Durable Medical Equipment and Prosthetics/Orthotics suppliers and represent both supplier types in all aspects of their legal needs. Wachler & Associates regularly counsel DMEPOS clients on matters including: Fraud and Abuse counseling including relationships with doctors to increase compliance with the Stark law and Anti- Kickback Statute. RAC, ZPIC, MAC, Medicaid, or private pay audits and appeals. Competitive bidding issues. Counseling for DME relationships with sleep labs. Operations, corporate governance, structural issues, and compliance policies.
Contractual and transactional arrangements. HIPAA compliance. Medicare enrollment and compliance.
Compliance with Medicare and Medicaid coding and payment regulations. Managed care contracting. Purchase and sale of DME companies. Consignment issues and physical location requirements. State registration and licensure. FDA compliance. Other regulatory and health care law matters. Back to top. DMEPOS Legal Experience.
Compliance Plans — Wachler & Associates has provided high quality compliance plans to providers and suppliers for over 2. We have developed and implemented comprehensive compliance programs, including compliance training and assistance with self- auditing. For example, we have counseled DMEPOS suppliers regarding their relationships with physicians and sleep labs to ensure compliance with the Stark law and the federal Anti- Kickback Statute.
Over the years, we have drafted workbooks on both HIPAA Privacy and Security and presented at seminars educating provider organizations across the country, including the American Orthotics and Prosthetics Association and the Michigan Orthotics and Prosthetics Association. We also specialize in counseling clients on compliance with Fraud and Abuse laws, Medicare and Medicaid regulations, and HIPAA. Purchase and Sale of DMEPOS Companies – Healthcare can be a precarious business in terms of audit and regulatory liability. As a result, purchasing a DMEPOS company requires thorough due diligence regarding the compliance of the existing entity with regulatory requirements and Medicare claims submission requirements. It is also important for purchasers to understand what steps must be taken in order to transfer Medicare billing privileges. In addition, there are warranty and indemnification provisions that purchasers can use to provide greater protection.
In many cases, Stark and other Fraud and Abuse laws may be applicable. The attorneys of Wachler & Associates have expertise in advising clients on purchasing and selling healthcare businesses including DMEPOS companies.
Audits – Medicare and third party payors often target DMEs in audits covering a range of risk areas. In 2. 00. 8, one in every four DME suppliers was penalized by Medicare. Our firm is a nationwide leader in RAC, ZPIC, Medicare, Medicaid, and third party payor defense. Please see our healthcare audit defense website for more information on how we can help you present the best defense possible. Purchasing and Supply Chain Agreements – The purchase and sale of medical equipment, products, and devices have several healthcare legal implications, such as fraud and abuse, HIPAA, FDA, and industry guidance. Our attorneys have significant experience in representing healthcare providers, suppliers and entities with regulatory compliance, acquisitions, and supply chain operations.
Our firm also has experience advising vendors, manufacturers, and distributors regarding sales and regulatory compliance. Our attorneys specialize in drafting, reviewing and negotiating contracts. Finally, we have extensive experience advising clients on regulatory issues concerning group purchasing organizations and physician- owned distributorships. Back to top. DME Recent Focus Areas. Financial relationships with physicians.
Medical director agreements. Billing requirements. Motorized wheelchair challenges.
Back to top. Prosthetics/Orthotics Recent Focus Areas. HIPPA compliance.
Prefabricated or custom items. Qui tam (Whistleblower) Cases. Financial relationships with physicians. Fee Schedule. Back to top. Outside Resources. For the Center for Medicare and Medicaid Services’ Durable Medical Equipment page, please click here.
Back to top. Articles. Our attorneys have written many articles on issues relevant to DMEPOS suppliers. For a list of Wachler & Associates articles, please click here. Back to top. Speeches. The attorneys of Wachler & Associates often speak on issues relevant to DMEPOS suppliers.
For a list of Wachler & Associates speaking engagements, please click here. Back to top. Contact Us. Call us at (2. 48) 5. DMEPOS- related concerns or to address your other healthcare law- related needs.