Medisys Compliance

DECEMBER 16, 2024

Skilled Nursing Facility (SNF) Medicare Part B billing is a specialized area of medical billing that requires detailed knowledge of Medicare guidelines, consolidated billing rules, and exclusions. Understanding Medicare Part B in SNFs Medicare Part B covers outpatient services provided to residents in a Skilled Nursing Facility (SNF).

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. As healthcare providers navigate the complexities of SNF billing, maintaining compliance is essential to avoid penalties, denials, and financial losses.

Compliance 52

Compliance Medical Billing Outsourcing Medicare Medicare 52

MRO Compliance

SEPTEMBER 19, 2023

The Centers for Medicare and Medicaid Services (CMS) Medicare Advantage Risk Adjustment Data Validation (RADV) audit season peaks from March through April every year. View Full Article  Health information (HI) professionals nationwide anticipate a looming tsunami of payer requests for medical records.

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Medicare Medicare Medicaid Medicaid 130

Medisys Compliance

FEBRUARY 27, 2024

Introduction Radiology billing compliance is a critical aspect of managing a successful radiology practice. With a myriad of regulations and the potential for audits looming, radiologists and billing staff need to have a solid understanding of compliance requirements.

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Compliance Medical Billing Outsourcing Medicare Medicare 59

Innovaare Compliance

DECEMBER 11, 2023

Before the Medicare Advantage Open Enrollment Period (MA OEP) [1] begins on January 1, 2024, Medicare Advantage Organizations (MAOs) still have time to review if they are completely ready for a new contract year. This blog article focuses on some of the “must make” changes to take effect as of January 1, 2024, or before.

Medicare 52

Medicare Medicare Compliance Medicaid 52

AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

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Compliance Officers Compliance Fraud Medicare 52

Healthcare IT Today

NOVEMBER 15, 2023

The previous article in this series explained some of the ways payers, providers, and digital health companies demonstrate that they have made a positive difference in their patients’ lives. ” This article looks at the measurements and reporting strategies used by some specific companies. offering in-home treatment.

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Medicare Medicare Hospitals Compliance 124

Healthcare IT Today

JULY 16, 2024

The following is a guest article by Nick Barger, PharmD, Vice President, Product at DrFirst. This article is the fourth in the Healthcare Regulatory Talk series. Preparing for the new standards now and understanding how they fit into the broader regulatory roadmap will position you well for future compliance.

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Compliance Medicaid Medicaid Medicare 124

MRO Compliance

JULY 12, 2023

Accurate, properly documented, interoperable patient data is required to achieve CMS’s goal for 100 percent of Medicare (and the majority of Medicaid) beneficiaries to be enrolled in some type of accountable, or value-based, care arrangement by 2030. View Full Article

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Medicaid Medicaid Medicare Medicare 130

Medisys Compliance

JANUARY 31, 2024

Introduction Understanding the details of Medicare coding and claims submission can be daunting for anyone. This article serves as a guide to help you avoid billing mistakes for Medicare and ensure smooth claims processing for your Medicare patients. Common Billing Mistakes 1.

Medicare 59

Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Medisys Compliance

JULY 15, 2024

Introduction As an internal medicine practitioner, staying updated with the latest Medicare billing changes is crucial for maximizing reimbursements and ensuring compliance. This article explores these changes, providing insights to help you navigate the evolving landscape of Medicare billing.

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Medicare Medicare Medical Billing Outsourcing COVID-19 59

Healthcare IT Today

JANUARY 17, 2024

The following is a guest article by Ritesh Ramesh, CEO at MDaudit Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments.

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Overpayments Overpayment Compliance Medicare 126

MRO Compliance

AUGUST 3, 2022

I recently wrote an article titled “Internal Audits Help Combat Payer Risk” where I described several keys for a smooth-running revenue cycle. By tracking and understanding audit activity, organizations can eliminate redundancy while filling in the gaps in revenue cycle compliance.

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Compliance Officers Medicare Medicare Compliance 130

MedTrainer

AUGUST 8, 2024

As of March 2024, over 67 million in the United States are Medicare beneficiaries. Medicare is the single largest payer for healthcare services in the United States. In FY2021, the Centers for Medicare and Medicaid Services ( CMS ) reported that Medicare processed more than 1.1 Here’s what you need to know.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Medisys Compliance

MARCH 5, 2024

This article explores into the details of cardiology billing, offering insights into payer audits and reimbursement challenges in cardiology billing. This complexity is reflected in the coding and billing requirements set forth by government payers such as Medicare, as well as private insurance companies.

Medical Billing Outsourcing 105

Medical Billing Outsourcing Medical Billing Compliance Governance 105

YouCompli

OCTOBER 16, 2024

Radiology services can be accompanied by some unique compliance challenges that do not always exist with other types of health care services. The following tips can help compliance professionals as they develop strategies to monitor compliance associated with typical radiology services. Any claim billed with ICD-10 code R51.9

Compliance 52

Compliance Medicare Medicare Hospitals 52

Medisys Compliance

JULY 19, 2024

Introduction The landscape of Medicare and Medicaid billing for behavioral health services has undergone significant changes recently. Understanding these updates is crucial for behavioral health providers to ensure compliance, maximize reimbursements, and continue delivering high-quality care.

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Medicaid Medicaid Medicare Medicare 52

YouCompli

AUGUST 22, 2023

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs.

Medicare 52

Medicare Medicare US Department of Health and Human Services Compliance 52

MedTrainer

FEBRUARY 7, 2024

The complex world of healthcare compliance demands a clear understanding of responsibilities. For those new to the role of compliance officer, the question often arises: “Who is responsible for compliance in healthcare?” Who is Responsible for Compliance in Healthcare?

Compliance 52

Compliance Compliance Officers Health Insurance Medicaid 52

Compliancy Group

JANUARY 3, 2024

This article discusses the issues related to medical billing compliance policy and the steps for providers to maintain financial integrity and adherence to all requirements. Medical billing compliance ensures that providers and administrators engage in ethical and accurate billing practices.

Medical Billing 52

Medical Billing Compliance ACA Health Insurance 52

MRO Compliance

JUNE 23, 2022

I recently wrote an article titled “Revenue Integrity: How to Reduce Costs and Retain Revenue” where I provided several tips on how to assess costs and resources and how to better prepare for audits to avoid denials. Maintaining and managing audits is one of the most time-consuming yet critical parts to ensure revenue integrity.

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Medicaid Medicaid Medicare Medicare 130

MedTrainer

JULY 29, 2024

Healthcare compliance is complicated for organizations of any size. However, the complexities grow exponentially for large or enterprise organizations with hundreds or thousands of employees who must complete and pass rigorous compliance training. What Is Corporate Compliance Training?

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Compliance US Department of Health and Human Services Regulatory Compliance Compliance Officers 52

MedTrainer

MAY 21, 2024

With the odds of a person entering your healthcare facility dealing with a behavioral or mental health issue at about 20% , new and existing clinical providers must receive behavioral health compliance training to ensure patients receive the highest quality care. Training requirements vary by role and specific healthcare setting.

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Compliance Medicaid Medicaid HIPAA 52

Hall Render

NOVEMBER 1, 2024

Health care fraud remains a significant focus for federal and state enforcement agencies, with particular attention placed on the integrity of Medicaid and Medicare billing. He was also ordered to pay $557,000 in restitution to Indiana Medicaid and Medicare. As such, providers should prioritize billing compliance.

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Fraud Compliance Medicaid Medicaid 40

YouCompli

SEPTEMBER 18, 2024

When conducting their periodic risk assessments, most compliance professionals use the OIG’s Work Plan or recent DOJ enforcement actions to help determine how best to deploy time and resources on auditing and monitoring efforts. Items and services that have high national error rates and are a financial risk to Medicare.

Compliance 52

Compliance Medicare Medicare Medicaid 52

MedTrainer

APRIL 8, 2024

As a healthcare professional, it is vital to maintain compliance with the 629 legal and regulatory requirements that govern the delivery of quality care. One effective tool to achieve this is through internal healthcare compliance audits. What Is an Internal Healthcare Compliance Audit?

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Compliance Governance ACA HIPAA 52

YouCompli

MARCH 22, 2023

According to the OIG, prior error rate testing has suggested an improper payment rate of almost 30% for Medicare. Urine Drug Testing Enforcement Specifics The enforcement and settlement amounts highlighted at the beginning of this article share some common alleged non-compliant behaviors.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Healthcare IT Today

NOVEMBER 22, 2022

The following is a guest article by John Wallace, PT, OCS, Senior Vice President of RCM at WebPT. The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. They also look to flag “items and services that have high national error rates and are a financial risk to Medicare.” What Triggers Audits?

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Overpayments Overpayment Medicare Medicare 111

AIHC

NOVEMBER 12, 2024

This article addresses how these privacy rights extend beyond rules designated under HIPAA and States passing rules banning unauthorized pelvic exams. These revisions resulted from recent articles, media reports, and concerns from nurses, some physicians, and medical students opposing these exams. [3],[4]

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Informed Consent HIPAA Compliance Hospitals 98

AIHC

AUGUST 30, 2023

This article is educational only, and does not provide consulting or legal advice. What compliance issues need to be considered when drafting a marketing strategy? Let’s take a closer look at potential compliance risks. For example, if you’re an Internist, what better way to promote articles on diabetes.

Compliance 52

Compliance Fraud Medicare Medicare 52

Medisys Compliance

APRIL 8, 2022

In this article, we briefly discussed these Medicare telehealth billing guidelines. CMS has finalized certain services added to the Medicare telehealth services list will remain on the list through December 31, 2023.This Reference: CY2022 Telehealth Update Medicare Physician Fee Schedule.

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Medicare Medicare Medical Billing Outsourcing COVID-19 59

MedTrainer

MAY 20, 2024

Understanding the differences in these requirements can ensure staff are taking the most relevant courses to maintain regulatory and accreditation compliance. In this article, we’ll explore the requirements for FQHC training and ways to simplify training delivery. However, meeting FQHC requirements is not as easy as it sounds!

Compliance 52

Compliance HIPAA Health Insurance Medicaid 52

YouCompli

AUGUST 16, 2023

As compliance officers, we are continually placed in a position to influence the actions of others. We conduct investigations, advise leadership, educate staff, and more, and it all plays a significant role in shaping our compliance culture. Always approach a compliance message with consideration of the audience’s point-of-view.

Compliance 52

Compliance HIPAA Medicare Medicare 52

MedTrainer

AUGUST 9, 2024

Establishing measurable compliance objectives enables organizations to track their progress, identify areas for improvement, and mitigate risks before they escalate into significant issues. But how do you write healthcare compliance goals that accomplish this? We’ll tackle that question and more in this article.

Compliance 52

Compliance HIPAA Governance Health Insurance 52

MedTrainer

JULY 11, 2024

Maintaining regulatory compliance has never been easy, and the pace of change isn’t slowing. In this article, I will share the impact of change on regulatory compliance and a few strategies to reduce disruption. Let’s start by defining regulatory compliance. What Is Regulatory Compliance?

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Regulatory Compliance Compliance Compliance Officers Hospitals 52

Compliancy Group

DECEMBER 8, 2023

Compliance is a critical aspect of the healthcare industry. However, there are several high-risk areas where compliance issues can arise, potentially leading to legal troubles and compromised patient safety. Billing and Coding Practices Billing and coding errors are another area where compliance issues can arise.

Compliance 52

Compliance Medicare Medicare Fraud 52

Medisys Compliance

JUNE 16, 2023

G0108 is a Medicare code used for the initial preventive physical examination, also known as the IPPE or “Welcome to Medicare” visit. In this article, we will explore the guidelines surrounding how often G0108 can be billed.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52