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CHECK THOSE SANCTIONS!

 
The OIG recently posted that a medical practice recently settled for  $192,699 for Employing Excluded Administrator.
 
Windham Eye Group employed Michael Vallone as its practice administrator between February 2010 and May 2021. Vallone had previously been convicted in the District of Jersey of health care fraud.  As a result of his conviction, he was excluded from all federal health care programs.  Windham Eye Group and its owners entered into a civil settlement agreement with the federal and state governments to resolve allegations that they improperly employed an individual who was excluded from all federal healthcare programs and agreed to pay $192,699. Read more about this case.
 
This is a good reminder that every individual needs to be reviewed at least annually against the OIG database of excluded individuals. Keep a log that shows your annual activity of monitoring your employees against the database.  To avoid potential liability, health care providers should check the List of Excluded Individuals/Entities on the HHS-OIG website.

 

CHECK YOUR MEDICARE PAYMENTS!
 
Everyone in our community should be checking on all 00537 services to ensure you are getting paid correctly! Noridian and NGS have released that they know the 00537 has been underpaid in 2022.  We would encourage you to look at all Medicare payments!  If you want help looking into it, we would be happy to help! 
 

The ACE Team
aceadmin@aceauditors.com

Want to join the ACE Team? We are hiring! 
The ACE coding team is growing and we are looking for certified anesthesia coders.  If you or anyone you know would be interested in being on the best team in the anesthesia industry we want to hear from you! 

Send resumes to: kaylal@aceauditors.com 
 

Are you getting paid for the services you performed? The ACE Revenue Integrity Analytics (RIA) Audit can look at a year’s worth of data!  This automated service reviews EVERY record in a specific time period. 

HOW IT WORKS:

  • Innovative machine learning distills large datasets into a single, easy to understand Excel format
  • Provides meaningful insights into the group’s monthly billing data
Please watch the video below that walks you through how the ACE RIA audit can help you and your group ensure that revenue is captured for services performed. 

Contact kaylal@aceauditors.com to inquire about booking. 

Watch RIA Audit Video

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We realize there are lots of questions swirling about the latest out of network rules. We presented on this is our most recent Code & Chat, but if you missed it you can now purchase the recording and the slides with our insights. Click here to purchase for $25.

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