Insights & Analysis
Practical guidance on PBM audits, federal investigations, compounding defense, DEA enforcement, telehealth compliance, and the regulatory pressures facing pharmacies and providers nationwide.
More articles — Page 24
Page 24 of 113 · 1018 articles
The Stark Law: What the Physician Self-Referral Ban Prohibits
What the Stark Law's physician self-referral ban prohibits: the referral, the financial relationship, and the bar on the Medicare…
Selective vs Non-Selective Debridement: CPT 97597, 97598 and 97602
Selective debridement (97597, 97598) and non-selective debridement (97602) are coded and reviewed differently, not interchangeable…
FDA's Bulk Drug Substance Categories 1, 2 and 3 for Compounders
FDA sorts nominated bulk drug substances into three interim categories, each carrying a different compounding posture and legal ex…
UPIC Medicaid Audits and the Medi-Medi Program
UPICs audit Medicaid claims too. How the Medi-Medi data match, the state's overpayment process, and MFCU referrals actually work.
Arterial Ulcer Documentation and Vascular Assessment Records
Medicare reviewers test arterial ulcer claims against the vascular assessment, perfusion findings, and whether the diagnosis code…
Common False Claims Act Violations in Healthcare, With Examples
A plain catalogue of the fact patterns that create civil False Claims Act exposure in healthcare billing, each with a short illust…
Patient Location in Telehealth Visits: Verifying and Recording It
A telehealth visit's licensure, prescribing authority, and billing rules all turn on where the patient actually was, not the addre…
Consignment Skin Substitute Inventory: Expired Product and Records
Grafts held on consignment create inventory and expiration records that auditors use to match every billed unit to the product tha…
Prescribing Across State Lines: Which State's Rules Apply
A telehealth prescription is governed by the patient's state, not the prescriber's. Compacts speed licensure, they do not replace…