Medical Necessity Monopoly: How to Avoid “Chance” and Advanced to “Go” ICD-10 Monitor – November 2018 by Karen Zupko and Michael Marks, MD, MBA A three-step medical necessity action plan can help ensure payment Consider the following: A patient presents to your office complaining of symptoms that indicate a possible herniated disk. A history notes symptoms...
Author: Michael Marks (Michael Marks)
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The Value of Claims ‘Signal’ Data in Orthopaedic Surgery
The Value of Claims ‘Signal’ Data in Orthopaedic Surgery AAOSNow – January 2019 by Michael Marks, MD, MBA In last month’s article, “Scientific Analysis for Medical Liability Claims,” Coverys’ Robert Hanscom, vice president of business analytics, and Lisa Simm, manager of risk management, presented the methodology the insurer utilizes to analyze medical professional liability (MPL) claims....
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Scientific Analysis for Medical Liability Claims
Scientific Analysis for Medical Liability Claims AAOSNow – December 2018 by Michael Marks, MD In orthopaedics, as in much of medicine, improvements in patient care are achieved when processes are developed to analyze outcomes. Medical professional liability (MPL) claims can serve as lagging indicators or signals of serious problems in the delivery of care. Medical liability...
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Don’t Be the Next Victim of Billing Fraud and Abuse
Don’t Be the Next Victim of Billing Fraud and Abuse AAOS Now- October 2018 By: Michael R. Marks, MD, MBA Every physician has scenarios they seek to avoid: bad nights on call, less than optimal outcomes, and the fear of malpractice suits. What many don’t think about are coding mistakes that could result in federal...
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Have You Heard the Latest Professional Liability Risk?
Have You Heard the Latest Professional Liability Risk? AAOS Now- June 2018 By: Michael R. Marks, MD, MBA HIPAA allows states to recognize cause of action for breach of confidentiality The list of liability risks for physicians continues to increase. On behalf of the Medical Liability Committee, this article presents new risks via highlights from...
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Are Physicians Required to Return Overpayments?
Articles Are Physicians Required to Return Overpayments? Michael R. Marks, MD, MBA Michael Sacopulos, JD AAOS Now – May 2018 When overpaid, many providers wonder if they need to return the funds. The short answer is yes. An overpayment is money that does not belong to providers and keeping it exposes them to collection and...
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Arthroscopy Coding for Major Joint – Shoulder
Articles Arthroscopy Coding for Major Joints – Shoulder Michael R. Marks, MD, MBA AAOS Now – March 2018 An accurate understanding of coding rules increases likelihood of receiving appropriate paymentCorrectly reporting and billing for arthroscopy services is often confusing. Last month, AAOS Now reviewed the knee arthroscopy codes and outlined the appropriate use of modifiers. This...
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Arthroscopy Coding for Major Joints – Knee
Arthroscopy Coding for Major Joints – Knee AAOS Now – February 2018 By: Michael R. Marks, MD, MBA When the American Medical Association (AMA) published the first edition of Current Procedural Terminology (CPT) to standardize surgical procedure terminology and reporting, modern arthroscopy was in its infancy and no CPT code described it. As the number...
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Have You Heard the Latest Medical Liability Risk?
Have You Heard the Latest Medical Liability Risk? AAOS Now – January 2018 By: Michael R. Marks, MD, MBA and Daniel R. Schlatterer, DO, MS Court rules that surgeons must personally deliver informed consent On June 20, 2017, the Commonwealth of Pennsylvania Supreme Court handed down a 4–3 decision that has the potential to rock the world...
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Medical Imaging and HIPAA Compliance
Medical Imaging and HIPAA Compliance AAOS Now – October 2017 By: Michael R. Marks, MD, MBA What orthopaedic surgeons need to know Last month, I coauthored an article on Health Insurance Portability and Accountability Act (HIPAA) compliance that offered tips on how orthopaedic practices can keep their patients’ information safe (see “Top 10 HIPAA Mistakes...
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