Urology Practice Management ™
PROCESS IMPROVEMENTS TO ENHANCE PATIENT CARE™
SEPTEMBER 2013
www.UroPracticeManagement.com
Current Developments in Medicare and Medicaid Audits By Sandy Paton
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t the American Urological Asso ciation’s annual meeting, recognized medical compliance expert Sean Weiss, CPMA, CPC, CPC-P, CCPP, ACS-EM, Chief Compliance Officer for DoctorsManagement in Knoxville, Tennessee, offered urologists and urology practice managers tips on how to avoid audits or—if luck turns the other way— how to survive them. How serious is the threat of being audited? According to Mr Weiss, it’s huge. Currently, 12 organizations can audit a medical practice at any given time, including Recovery Audit Contractors (RACs), Zone Program Integrity Contractors, Comprehensive Error Rate Testing, Medicaid Integrity Contractors, Centers for Medicare & Medicaid Services (CMS), and the Office of Inspector General. Any medical practice that has submitted a claim to Medicare or Medicaid is at risk for one Continued on page 8
VOLUME 2 • NUMBER 3
Medical Necessity in Coding: A New Risk in Recoupment By G. Amrit Khalsa
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edical necessity is defined as “healthcare services or products that a prudent physician would provide for the purpose of preventing, diagnosing, or treating an illness, injury, disease, or its symptoms (American Medical Association, Policy H-320[3], AMA Policy Compendium).” This definition is being
applied to payment guidelines that will affect how doctors practice medicine and how they charge for services. Denials for reimbursement that are associated with medical necessity are on the rise. All of these efforts are about balancing guidelines and directives, as practices are being pushed by the payer side to control healthContinued on page 9
The Regulatory Future of Urology Ancillary Services By Robertson Payton
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he Centers for Medicare & Medicaid Services (CMS) seeks to limit the scope of in-office ancillary services. At the American Urological Association (AUA)’s annual meeting, Julie E. Kass, JD, Principal of Ober|Kaler’s Health Law Group in Washington, DC, whose practice deals with regulatory aspects of the Stark law and the federal Anti-Kickback Statute,
described such services as advanced imaging (eg, computed tomography [CT], magnetic resonance imaging [MRI], positron emission tomography [PET] scans), anatomic pathology, radiation oncology, and lithotripsy.
Lithotripsy, a Red Flag Lithotripsy, Ms Kass noted, although not an ancillary service, is something Continued on page 12
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