Medical Billing Coding Michael Arrigo expert witness in Federal State and Civil Courts on Fraud, Affordable Care Act, HIPAA, Healthcare costs in malpractice and personal injury, drug pricing, False Claims Act cases involving Medicare Advantage and Electronic Health Records. Click here to contact. Medical billing coding work requires rendering opinions on the Usual Customary and [...]
In my work as an expert witness regarding the Patient Protection and Affordable Care Act (also known as the "ACA" or "Obamacare"), I find that more medical malpractice and personal industry cases as well as cases involving requirements for insurance coverage for self-insured employer's employees encompass ACA in their scope. The ACA may change the economics of healthcare as they apply to a legal matter involving damages, value of care, or insurance coverage and benefits.
CMS stated that its systems are being updated to accommodate ICD-10 NCDs and LCDs. This also resulted in "temporary" suspensions of payments for LCDs.
ICD-10 and Meaningful Use Webinar - Synergies, Workflows Risks and Opportunities Context and Learning Objectives The recent CMS / AMA announcement on ICD-10 implementation; who is now eligible for a reprieve on their ICD-10 completion date; and what it means for certain providers, health IT companies and payers The 10+ Meaningful Use Stage 2 measures [...]
Section 1886(s)(4)(C) of the Social Security Act, amended by sections 3401(f) and 10322(a) of the Affordable Care Act requires IPFs to report quality data for 6 quality measures starting in fiscal 2013 for Medicare beneficiaries. Beginning in FY 2015, two quality measures are added. Why does this matter in the context of ICD-10? The quality measures will be based on diagnosis and procedures coded in ICD-10 beginning October 1, 2015.
The inefficient markets theory is being reconsidered after the 2007 financial crisis in the U.S. Is it enough to provide the public with data on the cost of a service or alternative ways to purchase it? In healthcare the intersection of price, quality and sources of suppliers alone does not determine whether pricing is appropriate.
Clinicians are in a knowledge management crisis – massive amounts of data but getting the right information to clinicians, IT personnel and others at the right time is the challenge. What was missing from the RAND report were biomedical informatics perspectives.
ICD-1o and ICD-9 dual coding has been proposed in H.R. 3018 so called the Coding Flexibility in Healthcare Act of 2015 (Code-Flex) which aims to provide for a safe harbor period for the transition from ICD–9 to ICD–10 by allowing dual coding for six months after the ICD-10 transition deadline. The bill was introduced by [...]
Hospitals and the vendors of hospital based / inpatient systems do not get a reprieve and therefore still have the heaving lifting to do with ICD-10 CM, ICD-10 PCS procedure codes, and DRG based on the new coding system as mandatory requirements for compliance on October 1, 2015.
ICD-10 Deadline of October 1 2015 Reaffirmed by CMS and AMA "... Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes."
Affordable Care Act employer reporting requirements are effective as of January 1, 2015.
HR 2156, the Medicare Audit Improvement Act of 2015 legislation proposes changes to the Recovery Audit Contractor (RAC) program just in time for ICD-10