article thumbnail

What Is Medical Billing Compliance?

Compliancy Group

One of the most common ways for providers and healthcare organizations to run afoul is to incorrectly or illegally bill and code for services or supplies. No matter the intent, noncompliance in medical billing can have severe consequences. It pays to know the law and avoid temptations to cut corners.

article thumbnail

Lawsuit Alleges Obamacare Plan-Switching Scheme Targeted Low-Income Consumers

Kaiser Health News

In turn, sales agents used the information to either enroll them in ACA plans or switch their existing policies without their consent. Such private sector platforms, which must be approved by the Centers for Medicare & Medicaid Services, streamline enrollment by integrating with the federal ACA marketplace, called healthcare.gov.

ACA 136
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Mary Lou Retton’s Explanation of Health Insurance Takes Some Somersaults

Kaiser Health News

The ACA also includes subsidies that offset all or part of the premium costs for the majority of low- to moderate-income people who seek to buy their own insurance. residents struggle to afford the deductibles, copayments, or out-of-network fees included in some ACA or job-based insurance plans. of household income. 16 in most states.

article thumbnail

Two Healthcare Organizations Caught Up in Medicare Fraud Schemes

Compliancy Group

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

Fraud 52
article thumbnail

A Health Consumer Bill of Rights: Assuring Affordability, Access, Autonomy, and Equity

Jane Sarashon

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

ACA 113
article thumbnail

Reduced Co-Insurance for Screening Colonoscopies

Medisys Compliance

Section 4104 of the Affordable Care Act (ACA) defined the term ‘preventive services’ to include ‘colorectal cancer screening tests’ and, as a result, it waives any coinsurance that would otherwise apply under Section 1833(a)(1) of the Social Security Act for screening colonoscopies. Background for Reduced Co-Insurance. Reference: [link].

article thumbnail

Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?

Kaiser Health News

The former generally incurs no cost to patients under the ACA; the latter can generate bills. Remind your provider that the government’s interpretation of the ACA requires that colonoscopies be regarded as a screening even if a polyp is removed. Do you have an interesting medical bill you want to share with us?

ACA 106