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What To Do About Potential Whistleblowers at Your Facility Print E-mail
Written by Anne Novick Branan   
Thursday, 29 November 2012 00:00

The threat for health care providers of qui tam actions, also known as whistleblower lawsuits, under the federal False Claims Act ("FCA") is very real these days. Tough economic times and recent changes in the FCA protecting whistleblowers have made the lure of financial gain from qui tam actions more attractive to potential whistleblowers.

Under the FCA qui tam provision, persons with evidence of fraud against federal programs can sue the wrongdoer on behalf of the United States. The government has the right to intervene in such actions, but if the government declines, the private plaintiff may proceed on his or her own. Employees who bring qui tam actions can receive between 15 and 30 % of any monies recovered by the government. The FCA specifically protects employees who become whistleblowers from retaliation by their employers.

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About the Author: Ms. Branan is Of Counsel at Broad & Cassel.  Please click here to learn more. 
Re-Validation Tips Print E-mail
Written by   
Sunday, 25 November 2012 00:00


Q: How does the revalidation of Provider Enrollment Information Process work?

A:  When you receive your revalidation notice, you must respond either through internet-based PECOS, which is the most efficient way, or by completing the appropriate 855 application form. The first set...

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Source:  Coleman Consulting Group 
There is No Such Thing as a 10-Minute Office Visit Print E-mail
Written by   
Monday, 05 November 2012 09:07

The practice, the patients and the overseers of healthcare want each visit to be non-rationed, safe, high-quality, error-free, holistic, pleasant, clean, accurate, efficient and reimbursable. It's what we all want. And it isn't...

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5 Questions: A Deceptively Simple Performance Evaluation Print E-mail
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Friday, 02 November 2012 00:00

"The point of the '5 Questions' evaluation is not to underline that the employee is often tardy or doesn't complete assignments on time. Those things should be dealt with outside of this process. Remember the old adage: 'No new news at the performance evaluation'. ...the idea is to dig under those things and see if the employee is dissatisfied, overwhelmed or under-challenged."

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Minimize Claims Issues with One Simple Step Print E-mail
Written by M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC   
Sunday, 28 October 2012 00:00

Most physician practices experience claims challenges, from denials and rejections to payment inaccuracies.  As frustrating (and costly) as those issues are, they are almost avoidable with one simple step:  verifying patient insurance eligibility.

For patients covered by Medicare, it may seem like a waste of time to verify insurance after the initial visit.  However, how can you be sure the patient did not knowingly or erroneously enroll in a Medicare HMO with which you are not contracted?  You would continue to see the patient and find out only when your claims are rejected that you, basically, volunteered your services with this patient.   

For patients covered by Medicaid, eligibility can vary, so it's crucial to verify that the patient is still enrolled in the Medicaid system for every visit.

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About the authors: M. Alexandra Johnson, FACHE and Wilma N. Torres, CPC are principals at Coleman Consulting Group. The firm's services include:

· Risk Adjusted Reimbursement (MRA)
· Coding & Billing
· ICD-10-CM Consulting & Training
· EMR/Meaningful Use Attestation
· Credentialing & Contracting

For additional information about the firm or to request a complimentary no-obligation consultation, please call 954.578.3331 or email

Last Updated on Monday, 29 October 2012 09:26
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