Updated Compliance Resources!
Posted on 09.25.2013 Under Uncategorized

We’ve updated our “Compliance’ page to include these new resources from the OIG:



A link to OIG Compliance Training!

OIG Provider Compliance Training at oig.hhs.gov


A link to Consumer Fraud Alerts from the OIG

Beware of health insurance marketplace scams

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Healthcare.gov gets a facelift
Posted on 06.26.2013 Under Uncategorized

The recent re-launch of Healthcare.gov aims to be a one-stop shop for information on the Health Insurance Marketplace. Although, the Marketplace itself won’t be up and running until October 1st when open enrollment begins, the site does contains up to date information on what to expect for individuals or families, as well as small businesses.


Individuals and families can answer a few quick questions and the information most relevant to them will be displayed.


The Small Business Health Options Program (SHOP) Marketplace is for businesses of 50 (100 in Hawaii) or less full-time equivalent (FTE) employees. And starting in 2014, businesses with less than 25 FTEs will have to provide coverage through the SHOP Marketplace in order to qualify for the small business health care tax credit.



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New Website
Posted on 09.24.2012 Under News

Welcome to our newly designed website. Be sure to check back for more things to come.

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The OIG 2012 Work Plan Will Be Reviewing Modifiers Used During The Global Surgical Period
Posted on 04.11.2012 Under News

The OIG looking for improper payments made on Evaluation and Management (E&M) services is nothing new. This year’s Work Plan includes several items on E&M services, including services made during the global surgical period. New to this year they will also be looking at the modifiers used on E&M services performed during the global period.


According to the Work Plan “Prior OIG work has shown that improper use of modifiers during the global surgery period resulted in inappropriate

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CMS Postpones New POS Policy
Posted on 04.04.2012 Under News

In late March CMS announced that it was postponing the effective date for it’s new national policy regarding POS coding assignments. Transmittal 2435 delays the effective date from April 2nd 2012 to October 1st 2012.


The Transmittal revises and clarifies how POS codes are assigned. In the past the policy was to report the POS code for where the physician physically was when performing the services, under the new policy the POS code for where the face-to-face encounter was perform is to be reported. In cases where there was no face-to-face encounter, such as the professional component of diagnostic services, the POS code for where the technical component of the service was provided is to be reported.

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Documentation Isn’t The Only Thing Under Scrutiny
Posted on 04.04.2012 Under News

State and federal governments are using advanced technology to find suspicious billing patterns that would indicate upcoding or unbundling, and when they find suspicious patterns, they aren’t just looking at the documentation.


MedStar Health System’s Good Samaritan Hospital agreed to pay $793,548 to settle allegations that it submitted false claims to the to federal benefit programs from 2005-2008. They deny any wrongdoing and have released a statement saying the hospital “is committed 

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