CMS Targeted Probe & Educate Policy Program for Audits
Oct 05, 2017
CMS (Centers for Medicare and Medicaid Services) has announced in August of 2017 that it will start a new national audit strategy titled Targeted Probe and Educate (TPE). CMS had pilot programs in TPE...
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Managed Care Contracts: Watch out for Definitions Section Pitfalls
Aug 31, 2016
One of the most commonly overlooked components of a managed care contract is the definitions section despite the fact that what is contained here will affect the contracted provider on a daily basis. ...
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Medical Director Supervision requirements
Feb 18, 2015
Medical Directors are used in an administrative capacity to oversee all medical services and care, specifically referring to substance abuse programs and services. Increasingly, commercial healthcare...
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What Providers Need to Know Before They Balance Bill
Feb 09, 2015
Balance billing occurs when a provider collects from a patient the difference between the amount billed for a covered service and the amount paid for that service. Balance billing does not apply when...
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Standing Orders in Drug Treatment Programs: How to Avoid Waving a Red Flag
Feb 05, 2015
Medical necessity is the driving force for the payment of any service, but is especially worth noting when discussing laboratory testing. Standing Orders for urine drug testing in residential treatmen...
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Collecting Copays Now...Or Paying Later
Aug 26, 2014
Out-of-network physicians must remember that they should not only be collecting copayments and deductibles from their patients at the time of service and before they leave the office, but also that co...
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