Author: Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

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NGS Takes Over Medicare in Illinois: More of the Same?

On September 7, 2013, National Government Services (NGS) took over the contract as a carrier for processing claims and adjudication of Medicare in Illinois, Wisconsin, and Minnesota. Wisconsin Physician Services (WPS) was our former carrier for as long as I can remember. It is just a change in carriers, right? After all, it is still Medicare. Or is it?

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HIPAA Security Rule Compliance

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was implemented in four different phases to ensure compliance. The latest portion of HIPAA is the SECURITY RULE, which went into effect on April 21, 2005. All providers, except for small health plans, should have been in compliance by April 20, 2005. The exception for small health plans mandates that they must be compliant no later than April 20 of 2006.

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Avoiding Medicare and Medicaid Fraud and Abuse

Recently the U.S. Department of Health and Human Services, Office of Inspector General released a new publication booklet, “Avoiding Medicare and Medicaid Fraud and Abuse.”In its publication, the Government agencies (Department of Justice, the Department of Health and Human Services, Office of Inspector General, and the Centers for Medicare and Medicaid Services) outlined five of the most important federal laws affecting physicians’ offices. The Office of Inspector General recommends that physicians frequently conduct self-audits. In an effort to help with your recommended self-audits, I have provided a synopsis of the five most prevalent federal laws affecting our offices:

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