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Dental benefits under Medicaid.: An article from: Pediatric News

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This digital document is an article from Pediatric News, published by Thomson Gale on June 1, 2007. The length of the article is 839 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser.

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Title: Dental benefits under Medicaid.(Health P… More >>

Dental benefits under Medicaid.: An article from: Pediatric News

Georgia Health Insurance Medicaid Products

Georgia Health Insurance Medicaid Products

There are many different kinds of Georgia health insurance. Even when it comes to the federal program, Medicaid, there are three different companies that provide this Georgia health insurance program for children. AmeriGroup, Wellcare, and Peach State for Kids all offer Medicaid products to Georgia children. It is wonderful that those under the age of 18 have access to great Georgia health insurance products. These Georgia health insurance policies have some requirements for enrollment. Check with a Georgia government agency for specific information.

Other Georgia Health Insurance Offerings

There are seven large insurance carriers that offer Georgia health insurance. These are Aetna, Blue Cross Blue Shield, Cigna, Coventry, Humana, Kaiser Permanente and United Healthcare. These are some of the largest health insurance providers in the United States. It is exciting that we have such high quality Georgia health insurance products available to residents. Each of these companies contributes to the Georgia community also, by donations, as well as providing health and wellness opportunities to Georgia residents. Also, many of these companies have a national network of providers, so although the Georgia health insurance plan may be in Georgia, members still have access to nationally renowned physicians and hospitals.

Approximately 60% of the Georgia population has Georgia health insurance benefits, usually through their place of employment. However, Georgia has one of the worst ratings when it comes to residents who do not have Georgia health insurance. And Georgia is one of the few states that does not have a Georgia health insurance risk pool. These facts cause some concern among Georgia politicians. There have recently been focus groups, held in order to inform people about Georgia health insurance issues, as well as to prepare for how the health care reform may affect Georgia health insurance products.

Georgia Health Insurance for Small Business

There is also a lot of concern among small business owners regarding providing Georgia health insurance to employees. Many small business owners feel compelled to at least pay for a part of the Georgia health insurance monthly premiums for their employees. However, due to rising costs of being a business owner, many are having difficulty with this. Business owners report that workers’ compensation insurance and taxes require so much money that providing Georgia health insurance to their employees is difficult. A recent survey reported that most small business owners can contribute approximately $100 per month towards Georgia health insurance for their employees, but some of them believe this is not enough.

The good news is that the insurance companies that offer health insurance products in Georgia do offer Georgia health insurance products for small businesses also. In fact, any business with two or more employees, even those whose employees are family members, qualify for small business group plans. And often, group plans are the most affordable Georgia health insurance that anyone can get. Also, employees may be able to pay for their family members’ premium, lightening the load for business owners’ expenses. Business owners and employees need to meet together to come up with solutions to problems that may interfere with purchasing high quality Georgia health insurance.

About Author
Sam Dicosta shares his knowledge on health insurance that makes you able to find the plans that best fits your needs. If you want to know about Georgia Health Insurance, Individual Health Insurance Quotes, Medical Insurance, Aetna Family Health Insurance visit www.usa-healthinsurance.com

When Should You Get Health Insurance For You And Your Family?

There are some diseases, you should know them. They are simple, and they are easy to treat. But the snag is that the medication costs an incredible amount. Read the rest of this entry »

A Few Minor Billing Errors Aren’t Really Going to Matter, Right? Wrong!

When undertaking compliance measures, it is not uncommon to hear a physician attempt to justify the presence of billing errors by saying that the far majority of the billing is accurate and that one cannot worry too much about an occasional error here or there. Moreover, it is common to hear physicians say that they are not responsible for coding and that they heavily rely on coders to perform this function. Submitting claims with inaccurate coding can lead to false claims exposure for a physician even if the physician did not personally assign the code. Moreover, it is important to note that there need not be a pattern and practice of billing errors for legal exposure to occur.

A review of the recent unpublished decision in People v. Plymouth Road Dental, P.C. clearly demonstrates the importance of minimizing any and all billing errors. In People v. Plymouth Road Dental, P.C., both the dentist and the PC were bound over for criminal trial for numerous counts of alleged Medicaid fraud following the preliminary examination. At the preliminary examination, the government had introduced evidence regarding discrepancies between the billing invoices submitted by the dentist for 5 Medicaid patients and the work that had been performed. The dentist and the PC appealed to the circuit court emphasizing that the evidence demonstrated only 9 erroneous billings for 4 or 5 patients totaling slightly more than $300 in dispute (which is negligible compared to the thousands of patients seen in any given year) and that there were also instances of underbillings which would mitigate against an intent to bill falsely. The circuit court dismissed all of the charges based on the minimal number of claims involved and the resulting inference that the billings were thus more likely due to inadvertent error rather than a pattern of error sufficient to establish the knowledge element necessary for criminal prosecution. However, the Michigan Court of Appeals disagreed, causing the dentist and the PC to face a criminal trial, holding that: “the actual number of errors that are alleged, and the relatively small dollar figure they represent, is irrelevant and does not automatically convert or allow for the assumption, as proffered by the trial court, that the errors must have comprised only inadvertent mistakes. As previously determined by this Court, ‘if a defendant contractually agrees to abide by billing procedures and has access to the applicable manuals and documentation controlling those procedures, deviations from the established procedures are presumed to be intentional or provide evidence that the defendant knew the submitted claims were false.” (Citations omitted).

When billing for medical services and procedures it is essential that the precise code is submitted. Assigning codes that do not precisely match the service is not good enough. Coding using the “close enough” method creates compliance exposure. In today’s health care environment, physicians are well advised to educate themselves with regard to the codes that are applicable to their services and procedures and to make sure that those who are performing the coding function are monitored (e.g., via direct periodic reviews by the physician whose PIN is being submitted and/or via an audit conducted by a third party auditor retained by legal counsel to provide the appropriate attorney client privilege should errors be found). With regard to some services and procedures, Medicare and other third party payers have specific coding policies. These policies should be obtained and reviewed.

http://www.racattorneys.com

Andrew Wachler PhotoAbout Author
Wachler & Associates, P.C., is a law firm providing healthcare legal services to healthcare providers, suppliers and entities nationwide. Since 1980, the attorneys of Wachler & Associates, P.C., have successfully defended thousands of Medicare, Medicaid and other third party payor audits.
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