Design a compliance plan for the medical office.

The Affordable Care Act has mandated that all physician offices will need to have a compliance plan and compliance point of contact. Although the Office of Inspector General has not yet set the date, now is the time to get ready and design a compliance plan for your medical office. Fraud, waste, and abuse are at an all-time high. The government and taxpayers want to plug the holes where valuable healthcare dollars are being inappropriately used. Be proactive and take the time to design your compliance plan now. Read on to learn how to remove the question of "who, what, and I don't know" from your vocabulary when it comes to the topic of compliance!

Decoding incident-to and provider-based billing: ensuring payment and avoiding liability.

In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.

Changes to the federal Stark law that affect diagnostic imaging arrangements.

The Omnibus Budget Reconciliation Act of 1989 included an effort to prohibit self-referrals for services that has come to be known as the Stark law. Since its passage, the law has been modified a number of times to clarify ambiguity and address loopholes. This article describes changes made in 2007, specifically focusing on how those changes affect physicians who provide and refer for imaging services.