Provider News

Lawsuit Pushes Red Flags Rule Back — Again

Amidst an AMA lawsuit, the FTC appears to take a wait-and-see approach.

After a year’s worth of extensions of the Red Flags Rule, medical practices were ready to buckle down and ensure that their plans were in place, because the rule was set to take effect on June 1.

However, just days shy of that deadline, the Federal Trade Commission (FTC) announced that it would be delaying enforcement until Dec. 31, 2010, “at the request of several Members of Congress,” according to a May 28 FTC news release.

Under the Red Flags Rule, “certain businesses and organizations — including many doctor’s offices, hospitals, and other health care providers — are required to spot and heed the red flags that often can be the telltale signs of identity theft,” according to an article on the Federal Trade Commission’s Web site.

To comply with the Red Flags Rule, covered entities are expected to create a written red flags program to prevent and detect potential identity theft cases.

According to the FTC, the rule applies to businesses that qualify as creditors or financial institutions, and the FTC’s broad definition indicates that it applies to many medical practices. “Health care providers are creditors if they bill consumers after their services are completed,” the FTC Web site says. “Health care providers that accept insurance are considered creditors if the consumer ultimately is responsible for the medical fees.”

However, simply “accepting credit cards as a form of payment does not make you a creditor under the rule.”

Congress requested the delay in part to “pass legislation that will resolve any questions as to which entities are covered by the Rule,” the FTC press release indicated. “Congress needs to fix the unintended consequences of the legislation establishing the Red Flags Rule — and to...

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June 7, 2010
Audit / Hot Coding Topics / MAC / modifier 58 / modifier 78 / modifier 79

Global Billing: Document ‘Unrelated’ for Modifier 79 Services

MACs are looking for ‘red flags’ to halt additional global period pay Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims. After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt [...] Related articles:

  1. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
  2. Modifier Cheat Sheet: Banish Your E/M Modifier Phobias ForeverOnce you have this tool, you’ll never again wonder which...
  3. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...

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January 7, 2010
Coder's Cranium / CPT 2010

The ASC Coder’s Resource Guide for 2010

Here’s a quick, handy way to get to all of Medicare’s new rules and reimbursement rates Ambulatory surgery center coders have a lot to learn for 2010, stressed Joanne Schade-Boyce at the ASC 2010 Coding & Reimbursement Update in Orlando. It’s absolutely essential that ASC coders study the AMA’s CPT Changes this year, Schade-Boyce recommended. Why? [...] Related articles:

  1. Coder’s Anatomy: ‘Dorsal’Da Dum. Da Dum. DaDumDaDumDaDum. If you can’t always remember...
  2. A Coder’s Guide to Health Care ReformQuick way to show your practice you’re prepared for the...
  3. Op Note Decoder Ring: Red Flags for Multiple ProceduresNever rely on an op note’s “procedure performed” line for...

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December 12, 2009