The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / ACR/ARHP Annual Meeting 2012: Identify Compliance Risks to Avoid Violating Medicare Rules

ACR/ARHP Annual Meeting 2012: Identify Compliance Risks to Avoid Violating Medicare Rules

January 1, 2013 • By Mary Beth Nierengarten

  • Tweet
  • Email
Print-Friendly Version / Save PDF
Audit flowchart. Many carriers will only give you one opportunity to submit records, so submit everything needed to support the level of service billed by the deadline stated in the original letter. The ACR recommends that you submit requested documents by certified mail so that you have proof that you complied with the request.

You Might Also Like
  • Avoid Compliance Risks When Using Billing Companies
  • Clinical Opportunities at the 2012 ACR/ARHP Annual Meeting
  • 2012 ACR/ARHP Annual Meeting Scientific Program Preview
Explore This Issue
January 2013
Also By This Author
  • Meditation May Help Prevent Physician Burnout
Top Ten Compliance Risks
click for large version
Table 1: Top Ten Compliance Risks

WASHINGTON, D.C.—To reduce the potential risk of submitting improper claims for payment or other violations of Medicare regulations and laws, rheumatologists and healthcare providers who participate in Medicare and other federal health benefits programs should develop, implement, and adhere to a personalized effective compliance plan, a legal expert said during a session titled, “Top 10 Compliance Risks Facing Physicians” here at the 2012 ACR/ARHP Annual Meeting, held November 9–14 in Washington, D.C. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

According to Robert W. Liles, Esq.—an attorney at Liles Parker PLLC in Washington, D.C. who specializes in medical compliance issues—the Secretary for the Department of Health and Human Services (HHS) may require all participating providers to have a comprehensive compliance plan under the Patient Protection and Affordable Care Act. Although Liles said no mandatory date has been set for rheumatologists to comply with this requirement, he expects the date to be announced sooner rather than later.

“Rheumatologists are under the radar,” Liles told a roomful of specialists at the annual meeting. “Like oncologists, they often dispense extraordinarily costly drugs, such as the biologics infused to patients suffering from chronic disease,” he added. “In light of the multiple layers of private Medicare and Medicaid contractors currently engaged by the government to ferret out alleged overpayments and fraud, everyone in this room will likely be audited at some point in the future,” he emphasized.

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

To help educate rheumatologists on some of the compliance risks they currently face or may face in the near future, Liles discussed the top 10 risks to physicians in private practice (see Table 1, below) and 10 easy steps that physicians can implement to reduce their risk of noncompliance with the law (see “Ten Easy Steps to Improve Your Compliance,” p. 32).

Among these, Liles talked about a type of Medicare contractor that focuses almost entirely on nonhospital providers, including rheumatologists in private practice. Called Zone Program Integrity Contractors (ZPICs), they are “knowledgeable of the ‘ins and outs’ of Medicare’s most complex billing practices, and are adept at using sophisticated data mining techniques to identify and target physicians and other providers who appear to be outliers when compared to their peers,” Liles said.

Pages: 1 2 3 | Single Page

Filed Under: Legislation & Advocacy Tagged With: ACR/ARHP Annual Meeting, compliance plan, compliance risk, Medicare, RegulationIssue: January 2013

You Might Also Like:
  • Avoid Compliance Risks When Using Billing Companies
  • Clinical Opportunities at the 2012 ACR/ARHP Annual Meeting
  • 2012 ACR/ARHP Annual Meeting Scientific Program Preview
  • The ACR/ARHP Annual Meeting: Focus on Practice

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2022 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)