One of the best ways to avoid problems with Medicare or private payers is to comply with the laws, rules and regulations for billing of services. This means:
- Following proper coding conventions
- Documenting services adequately in patient records
- Reviewing coverage policies frequently.
In so doing, cardiology practices can reduce the likelihood of being audited or the potential damage resulting from such an audit. ACC offers resources on how to be compliant in the following categories.
Through this process, payers request a variety of information from clinicians and/or their employers on licensure, contact information, schooling, practice history and more. Find out more >>>
Virtually all adverse determinations made regarding Medicare claims can be appealed using Medicare's formal appeals process. Find out more >>>
Neither federal nor private payers will pay for all available therapies and services. Instead each payer has set up its own complex system of rules that determine what services and therapies will be covered when. Find out more >>>
The audit programs use various methods of reviewing claims and have distinct purposes, but ultimately, the goal remains the same: protection of the Medicare Trust Fund and beneficiary premium dollars. Find out more >>>
Proper documentation is critical to justifying medical necessity and selection of codes for billing. Find out more >>>
Fraud & Abuse
There are both federal and state laws and regulations that are regularly implicated during health care transactions. Find out more >>>
Recovery Audit Contractors (RACs)
Recovery Audit Contractors (RAC) are one of several types of contractors used by CMS to recover inappropriate Medicare payments. Find out more >>>