Compliance & Regulation
HIPAA, No Surprises Act, Stark, MIPS and state law. 12 entries.
An Advance Beneficiary Notice of Noncoverage (ABN, CMS form CMS-R-131) is a written notice given to an Original Medicar…
Anti-Kickback Statute (AKS): Remuneration for ReferralsThe Anti-Kickback Statute (AKS, 42 U.S.C. 1320a-7b(b)) is a federal criminal law that prohibits knowingly offering, pay…
CMS 60-Day Overpayment RuleThe 60-day overpayment rule, from Section 6402 of the Affordable Care Act, requires providers to report and return Medi…
False Claims Act (FCA): Liability for False Medicare/Medicaid ClaimsThe False Claims Act (FCA, 31 U.S.C. 3729) is the government's primary tool against health-care fraud. It imposes liabi…
HIPAA: Privacy, Security, and Transaction Rules for BillingHIPAA (the Health Insurance Portability and Accountability Act of 1996) sets national standards for protecting patient …
HITECH Act: Health IT and Strengthened HIPAA EnforcementThe HITECH Act (Health Information Technology for Economic and Clinical Health Act, 2009) promoted adoption of electron…
Incident-To Billing: Rules for Billing NPP Services Under a PhysicianIncident-to billing is a Medicare rule that lets services by non-physician practitioners (NPs, PAs) be billed under the…
MUE: Medically Unlikely EditsMedically Unlikely Edits (MUEs) are CMS-set limits on the maximum units of a CPT/HCPCS code payable for one patient on …
Medical Record Documentation: The Foundation of Compliant BillingMedical record documentation is the written clinical record that supports every billed service. The governing complianc…
NCCI Edits: National Correct Coding InitiativeNCCI (National Correct Coding Initiative) edits are CMS-maintained code-pair rules that prevent improper payment when c…
OIG Work Plan: HHS Office of Inspector General Audit PrioritiesThe OIG Work Plan is the HHS Office of Inspector General's published, regularly updated list of audits, evaluations, an…
Stark Law: Physician Self-Referral ProhibitionThe Stark Law (the physician self-referral law) prohibits a physician from referring Medicare or Medicaid patients for …
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