Healthcare IT Today

NOVEMBER 22, 2022

The following is a guest article by John Wallace, PT, OCS, Senior Vice President of RCM at WebPT. Auditors may also perform technical audit reviews, medical necessity compliance reviews, and medical policy reviews. The payer could also recoup the overpayments from future visits. . What Triggers Audits? .

Overpayments 111

Overpayments Overpayment Medicare Medicare 111

YouCompli

NOVEMBER 1, 2023

As compliance officers, we are continually placed in a position to influence the actions of others and help shape our organization’s compliance culture. One way to change that perception is to avoid creating “gotcha” moments when you’re working on a compliance-related matter. Here are four tips that will help.

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

YouCompli

OCTOBER 26, 2022

Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge. And the Compliance team simply doesn’t have the clinical expertise to own the monitoring of these requirements. That’s a 41% error rate with an extrapolated overpayment of?$269 Don’t let processes overwhelm clinical colleagues.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

FEBRUARY 1, 2023

Using the OIG’s seven elements as a guide to delivering better patient care Healthcare Compliance professionals tend to focus, rightfully so, on the regulations and organization requirements around providing quality patient care and keeping patients safe. Compliance officers have three main roles in this.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

MAY 17, 2023

Sharon Parsley, JD, MBA, CHC, CHRC contributes a regular post on compliance officer effectiveness for the YouCompli blog. In this article she discusses relationships and collaboration with other key risk assurance functions. In a previous article, I discussed relationships with operational areas such as Nursing Revenue Cycle, and IT.

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Compliance Compliance Officers Overpayments Overpayment 52

YouCompli

DECEMBER 14, 2022

Sharon Parsley, JD, MBA, CHC, CHRC contributes a monthly post on compliance officer effectiveness for the YouCompli blog. In this article she looks at specific ways to engage and communicate with Nursing, Physicians, Sales & Marketing, Revenue Cycle, and IT. In the process, they became compliance champions.

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Compliance Compliance Officers Nurses Overpayments 52

Hall Render

JANUARY 10, 2025

Background CMSs 60-Day Rule is a regulation under the Affordable Care Act (“ACA”) that requires health care providers and suppliers to report and return identified Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply can result in liability under the FCA. The rule is codified at 42 U.S.C.

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Overpayments Overpayment ACA Medicare 40

AIHC

SEPTEMBER 30, 2024

Written by Joanne Byron, BS, LPN, CCA, CHA, CHCO, CHBS, CHCM, CIFHA, CMDP, OHCC, ICDCT-CM/PCS Does your compliance program include auditing and monitoring documentation and coding related to risk adjustments and your value-based care reimbursement? This short article provides a basic overview of this complex topic.

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Overpayments Overpayment Compliance Medicare 52

Hall Render

NOVEMBER 25, 2024

Department of Health and Human Services (“HHS”) issued new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (“Nursing Facility ICPG”) for nursing home members of the health care compliance community. On November 20, 2024, the Office of Inspector General (“OIG”) for the U.S.

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Nurses Compliance Compliance Officers Medicare 40

Hall Render

DECEMBER 11, 2024

OIGs new Industry Segment-Specific Compliance Program Guidance For Nursing Facilities (Nursing Facility ICPG) for nursing home members of the health care compliance community emphasizes the importance of staff screening and exclusion checks. Hall Render blog posts and articles are intended for informational purposes only.

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Compliance Licensing Nurses Medicaid 40

YouCompli

SEPTEMBER 27, 2023

Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies and whistleblowers are increasingly scrutinizing modifier usage, and because of that compliance programs should be as well. Get the latest from healthcare compliance experts  Never miss an article from CJ Wolf.

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Compliance Overpayments Overpayment Medicare 52

Compliancy Group

FEBRUARY 7, 2024

For healthcare organizations, understanding UPIC audits and preparing for them is essential to compliance. This article explores the purpose of UPIC audits and who should be concerned – providing a comprehensive guide on how healthcare organizations can prepare for these audits. What is the Purpose of UPIC Audits?

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Fraud Compliance Medicare Medicare 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Integrating this strategy into your compliance culture can help your organization avoid penalties and deliver compliant patient care. For staff, compliance officers should support annual online FWA compliance training.

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

Healthcare IT Today

FEBRUARY 2, 2024

The following is a guest article by Tom Magnotta, COO & President at Apixio Albert Einstein famously said , “Whoever is careless with the truth in small matters cannot be trusted with important matters.” This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected.

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Payment Systems Overpayments Overpayment Medical Billing 78

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Global billing or collaborative care arrangements are not per se violations of the Anti-Kickback Statute, however, there is greater fraud and abuse risk in these types of arrangements unless there is active, ongoing monitoring for compliance.

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Hospitals Compliance Officers Compliance Overpayments 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This article is not intended as legal or consulting advice. Telehealth rules and regulations vary greatly by state.

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COVID-19 Telemedicine Informed Consent Compliance 59

AIHC

OCTOBER 23, 2024

Internal audits can be an integral part of your corporate compliance program and used as an effective management system, whether it is focused on quality, safety or any other business element. The information provided in this article is not comprehensive and not intended as consulting or legal advice.

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Compliance Overpayments Overpayment Medicaid 52

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim.

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Fraud Medicare Medicare Compliance 52

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. Episource works with a regional healthcare organization that has added an annual compliance retrospective in the months leading up to the final submission deadline. To that end, the agency doubled its budget for audits in 2022.

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Medicare Medicare Overpayments Overpayment 69

Healthcare IT Today

MAY 5, 2023

The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient.

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Fraud Medicare Medicare Overpayments 72

AIHC

MARCH 28, 2022

Written by: AIHC Blogger This article provides educational information related to fighting unreasonable denials by working through a complex payer appeals process. This information is not all-inclusive and the article is a truncated version of Lesson 3 from our Certified Outpatient Clinical Appeals Specialist (COCAS SM ) training program.

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Medicare Medicare Compliance Governance 52

Medisys Compliance

MARCH 7, 2022

In this article, we shared some basic guidelines and recent trends in medical audits and what providers can expect in such payer coding audits. In the unfortunate event when you receive such overpayment demand letters, don’t acquiesce without conducting an analysis first. What just happened? How could they do this?

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Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52

AIHC

MARCH 22, 2022

This article provides a basic overview of the importance of improving your appeals process to get denials overturned as it relates to overall revenue cycle management. Monitor Reports for Inappropriate Write-Offs Are accounts reconciled and overpayments identified and handled properly?

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Overpayments Overpayment Medicare Medicare 52

Healthcare IT Today

JANUARY 13, 2025

Check out our community’s Healthcare Regulations and Healthcare Compliance predictions: Shubh Sinha, CEO at Integral In 2025, compliance will get a seat at the decision-making table. Until now, senior leaders have viewed compliance as a box to check off or, worse, a bottleneck to innovation.

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Compliance Compliance Framework HIPAA Governance 99