Two Fundamental Tuesdays

Ins and Outs of The Billing Company Contract

Tuesday, September 29, 2020 (2-2:45 EST, 1-1:45 CST; 12-12:45 MST, 11-11:45AM PST)

As enrollment challenges have increased, new CPT codes have emerged and the penalties for failed billing have increased, many physician practices have turned to outside billing companies to perform these activities for them. The contracts by which this happens do not get the attention they deserve. Many physician practices do not demand the accountability they should from their billing agents. These issues are compounded when the billing function is embedded in a much larger management contract with a health system, an MSO or some other entity. In this crisp, focused half hour session with fifteen minutes of Q & A and a 12 page substantive handout Alice Gosfield will elucidate many of the hidden whammies that lurk here.

  • What are the fee options?
  • How to use performance metrics
  • How are responsibilities allocated?
  • Communication regarding overpayments
  • HIPAA and data issues
  • What the OIG says about these companies
  • Effects of termination
  • …and more

If you can't join us on the 29th but would be interested in an MP3 recording to download, including the presentation with Q & A and the handout for the same $275, please see below for recorded session.

Unraveling The Pitfalls in Medicare Physician Office Diagnostic Testing

Recorded: Tuesday, September 22, 2020

Diagnostic testing is a critical element of physician practice billing. However, offering these crucial services to the public, physicians providers must navigate Medicare's regulatory maze. From the basic reimbursement and supervision rules, to Stark, to the Anti-Markup Rule, to distinguishing billing by IDTFs, the regulations can be confounding. This crisp, focused half hour session with fifteen minutes of Q & A and a 12 page substantive handout Dan Shay will clarify the confusing crossroads of Medicare's regulations governing physician office-based diagnostic testing (except for clinical laboratory).

  • Basic Diagnostic Testing Reimbursement Rules
  • Medicare's Ordering and Supervision Rules
  • Diagnostic Testing vs. Incident-To
  • Stark: Groups, Internal Compensation, and Diagnostic Testing
  • The Anti-Markup Rule and How to Avoid It
  • IDTFs and Their Role in the Diagnostic Testing Space

$275 each
Billing Company Contract alone - LIVE teleconference
Billing Company Contract alone - Recorded
Diagnostic Testing alone - Recorded

$450 together
Billing Company Contract LIVE and Diagnostic Testing Recorded
Both teleconferences - Recorded 


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Previous Teleconferences


Two Payment Thursdays

Recorded March 21, 2019 and April 4, 2019

The new Medicare Physician Fee Schedule introduces 4 entirely new ‘visit’ codes and 3 documentation changes effective immediately. There are also 3 new ‘visit’ codes for 2021 (with new payment) and new documentation options effective then. This session will focus on these issues only, which will challenge physician practices to manage effectively. We offer an 8 page handout with citations to the applicable policies and links to 4 additional free relevant articles.

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Inducing Beneficiaries: Do's and Don'ts

Recorded April 24, 2018

For many years, our solid legal guidance to physicians about what they could do to benefit their patients without running afoul of the fraud and abuse laws has been restrictive.

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LESSONS LEARNED FROM LEASING: A DEEPER DIVE

Recorded October 26, 2017

Five years ago, we presented a teleconference on the pros, cons and practicalities of a group practice leasing itself to a hospital or health system, in lieu of employment. The group remains intact.

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Social Media and "BYOD": What Are Your Risks?

Recorded June 22, 2017

Social media usage is a fact of modern life. Facebook has over 1 billion active users, which undoubtedly includes physician practice employees. Physician practices also may want to establish there own social media presence, to connect with current and potential patients. 

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How Secure Do You Feel About Your HIPAA Compliance Plan?

Recorded December 6, 2016

The HIPAA Security Rule compliance stakes have risen. The Office of Civil Rights is currently enforcing against physician practices, and conducting audits of small practices and business associates alike.

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For Whom The Sixty Day Bell Tolls: Risk and Reward in Physicians Returning Overpayments

Recorded April 19, 2016

With less than a page of actual regulations, but 25 pages of discussion, the regulations addressing when and how to repay overpayments have some surprising elements. What triggers the obligation to report is now much broader than most people realize. 

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Beyond Face Time

Recorded February 2, 2016

Reports of the demise of fee for service are entirely premature. In fact, Medicare has introduced new codes to pay physicians for services that do not require that they have a face to face encounter with the patient.

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Is Your Group A Group?

Recorded May 5, 2015

The August, 2014 Stark settlement with the OIG and DOJ for $1.33 million dollars by a New York private practice cardiology group for its internal compensation practices should be seen as a call to arms.

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Unraveling The Knots: Stark and Medicare Reimbursement Principles and Intertwinings

Recorded July 15, 2014

Given the draconian impact of enforcement, it is clearly time to revisit some of the lurking pitfalls in the connection between the Stark law and Medicare reimbursement principles.

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Using Patient Safety Organizations to Bolster Clinical Integration

Recorded January 28, 2014

The demand for providers to change the way they deliver care to demonstrate more value is rampant. To make those changes requires clinical integration which centers, in essence, on analysis of data -- data that by definition demonstrates sub-optimal performance.

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Quality Fraud: What Is That?

Recorded February 14, 2013

This highly focused half hour of lecture with 15 minutes for questions will offer to hospitals and their compliance officers and physician practice groups a much better understanding of looming pitfalls which can be avoided with attention.

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Physician-Hospital Alignment Strategies

With health reform now moving inexorably forward, the implications of value-based payments, bundled payments, and reorganized care delivery - particularly for physicians - must be confronted.

  1. Leasing The Practice To The Hospital: Pros, Cons and Practicalities - (Sept. 11, 2012)
  2. A Physician's Perspective on Co-Management: Opportunities and Pitfalls - (Sept. 18, 2012)
  3. Governance and Contractual Issues Within Bundled Payment: The Physician Perspective - (Sept. 25, 2012)

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The Physician Compensation Challenge: Stark and Responding to The New Value Demands

Recorded June 19, 2012

This teleconference will explain the rules, debunk the myths and offer new information about how leading edge groups are increasingly moving to make their internal compensation models consistent with external demands for improved quality and value.

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