Category: Affordable Care Act

What Medicaid Providers Need to Know about CIA’s and How They Can Affect Your Practice

I don’t know the backstory regarding MB2 Dental’s Corporate Integrity Agreement (CIA). Here is what I do know: ·      Corporate Integrity Agreements have become a favorite tool of the OIG. ·      You can gain valuable insights on how to protect your practice by reading CIAs (and other government enforcement actions). Every CIA includes requirements that the organization [..]

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Will Trump trump Obamacare?

Donald Trump, whether he is an ace in the hole or a fart in the wind we have to keep on keeping on. November’s presidential election was perhaps the surprise of the century. In the aftermath, everyone on both sides of the aisle have so many questions and are filled with all kinds of speculation. [..]

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I Hate Compliance

Really. I hate the word “Compliance.” It kind of makes me feel like I am giving up a part of myself. It makes me feel like Captain Picard staring out his ship’s screen looking at this overwhelming monster-The Borg, demanding submission. Maybe I am just a nerd like that? Does compliance irk you too? WARNING: [..]

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We Need to Talk: It’s About Section 1557 of the Affordable Care Act and How It Impacts Your Dental Practice

Does your practice receive reimbursements from Medicare? Medicaid? C.H.I.P.? How about Tricare? If so, you need to read how this new law Section 1557 will impact your practice! Regardless of how you feel about it one thing is certain – the Affordable Care Act (ACA) is full of surprises! Let’s look at Section 1557. The [..]

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Government Fines Increasing (and Why You Should Take Note)

In less than 7 minutes I will convince you to get rid of Medicaid, Get a Compliance Program or Surrender your Dental License. Will you accept my challenge? OSHA’s Fine Increase OSHA recently announced they are raising their maximum fines amounts. Effective August 1, 2016 maximum fines for serious violations will jump from $7,000 per [..]

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Outliers and Auditors

Few people enjoy having someone look over their shoulders and mind their business. Now, more than ever, ‘outsiders’ will be minding your business. Insurance carriers, like Medicaid organizations, are watching dental insurance claims to identify ‘outliers’ or those who stick out as compared to their peers in the number and type of claims submitted for [..]

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Dentist Faces 35 Years in Prison for Billing Errors You Have Probably Made this Week!

On August 11, 2015 the Hartford Currant published a news article that should terrify every dentist who participates with Medicaid. Whether you are a Medicaid provider or not sit down and read this! Dr. Thomas DeRienzo, owner of Plantsville Family Dentistry in Plantsville, Connecticut, “was charged with first-degree larceny by defrauding a public community, second-degree [..]

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The Case for Dental Record Auditing

Sadly, few dental practices audit patient records. A lot can be learned from auditing including identification of incomplete or inadequate documentation/ paperwork, missed billing opportunities, issues that can result in recoupments (even criminal prosecution), and a host of other issues. Physician practices and hospitals routinely audit for compliance, risk management, revenue cycle and quality of care [..]

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