McBrayer Law Blog

NOVEMBER 18, 2020

Posted In Code Enforcement , Hospitals It may seem like hair-splitting, but including the wrong diagnostic codes for malnutrition on hospital inpatient claims – using codes for severe malnutrition in place of other forms of malnutrition – is a costly mistake.

Compliance 52

Compliance Overpayments Overpayment Medicare 52

YouCompli

MAY 17, 2023

Sharon Parsley, JD, MBA, CHC, CHRC contributes a regular post on compliance officer effectiveness for the YouCompli blog. What does it really take to ensure that an organization has a mature, well-integrated, and high-performing Compliance function? Hopefully, both Compliance and Legal are involved in your contract approval processes.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

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.

Compliance 52

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

Health Care Law Brief

APRIL 12, 2023

We note, however, that an MA plan may elect to offer, as a Medicare benefit, coverage for post-hospital skilled nursing facility care without a prior qualifying hospital stay that is required under traditional Medicare. Final Rule at p. 3729(b)(1)(A) of the False Claims Act (“FCA”). See Proposed Rule at 79559. See 42 U.S.C.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Healthcare Law Blog

FEBRUARY 9, 2024

million to resolve a lawsuit filed by the system’s former Chief Compliance Officer, Ronald Sherman. Following the resolution of this case, hospitals are encouraged to revisit their arrangements with private physician groups to ensure that proper safeguards are in place to mitigate FCA risk.

Hospitals 52

Hospitals Compliance Officers Compliance Overpayments 52

Healthcare IT Today

JANUARY 17, 2024

Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion. Those are the high-level findings of MDaudit’s 2023 Benchmark Report on the trends, challenges, and opportunities encountered by U.S.

Overpayments 115

Overpayments Overpayment Compliance Medicare 115

Healthcare IT Today

NOVEMBER 22, 2022

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. . Meanwhile, Medicare also has a Fee for Service Recovery Audit Program. What Triggers Audits? . There are only so many hours in the day.

Overpayments 104

Overpayments Overpayment Medicare Medicare 104

Compliancy Group

FEBRUARY 29, 2024

By examining the purpose and regulatory mechanisms of these agreements, we can understand their role in ensuring compliance, promoting ethical conduct, and ensuring patient and employee safety. When a hospital, doctor’s office, or other healthcare organization is guilty of a regulatory or compliance violation , the U.S.

Compliance 52

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. Many people in our discipline love the slogan “compliance is everybody’s business.” In the process, they became compliance champions. Seize every opportunity to demonstrate that compliance is not the police.

Compliance 52

Compliance Compliance Officers Nurses Overpayments 52

Healthcare Compliance Blog

APRIL 14, 2022

The Office of Inspector General (OIG) released their findings of an audit they conducted to determine if hospital admissions of Indiana skilled nursing facility (SNF) residents who are enrolled in both Medicare and Medicaid (dually eligible beneficiaries) were potentially avoidable, and if level-of-care requirements for Medicare were met.

Medicare 59

Medicare Medicare Overpayments Overpayment 59

The Health Law Firm

JULY 26, 2012

On July 2, 2012 the Officer of Inspector General (OIG) released its Medicare compliance review of West Florida Hospital in Pensacola. According to the audit, the hospital complied with Medicare billing requirements for the documentation majority of inpatient and outpatient claims. Official Break Down of the Audit.

Medicare 40

Medicare Medicare Compliance Overpayments 40

Compliancy Group

FEBRUARY 7, 2024

For healthcare organizations, understanding UPIC audits and preparing for them is essential to compliance. Through a combination of data analysis, investigations, medical reviews, and site visits, UPICs scrutinize healthcare providers and suppliers to ensure compliance with billing rules and the provision of medically necessary services.

Fraud 52

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.

US Department of Health and Human Services 52

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

Healthcare IT Today

FEBRUARY 2, 2024

Payment integrity is essential for ensuring financial accuracy, maintaining compliance with regulations, optimizing the healthcare delivery system, and removing administrative waste, which impacts the focus on patient care and quality outcomes. This reactive model leads to only ~70% of identified overpayments being recovered and/or corrected.

Payment Systems 66

Payment Systems Overpayments Overpayment Medical Billing 66

Innovaare Compliance

JUNE 28, 2022

Compliance Standard and Method of Evaluation are outlined in the protocol. . This causes claims to providers to be paid incorrectly, which results in enrollees being overcharged for their coinsurance or delayed refund of overpayments. . Contact us today! .

Overpayments 52

Overpayments Overpayment Compliance Medicare 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. Telemedicine is considered to be under the umbrella of telehealth and refers specifically to clinical services.

COVID-19 59

COVID-19 Telemedicine Informed Consent Compliance 59

AIHC

APRIL 5, 2022

If the payer, such as Medicare, performs an extrapolation, reducing each overpayment dollar through appeal can mean thousands less to pay back. If the claim is coded POS 11 for the office, reimbursement can be higher than if the same service was performed at the hospital by the provider. at: [link] Is the date of service (DOS) correct?

Fraud 52

Fraud Medicare Medicare Compliance 52

Hall Render

JUNE 30, 2023

for physician referral scheme In Los Angeles, hospital CEO pay could be capped Kaiser Permanente ratings affirmed amid healthy financial profile Nurses vote ‘no confidence’ in California hospital administration, board Nursing facility, management company settle physician kickback allegations for $3.8M Here’s why.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 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. The hospital ultimately settled and agreed to pay $3.3 CJ Wolf, MD, M.Ed.

Compliance 52

Compliance Overpayments Overpayment Medicare 52

AIHC

MARCH 28, 2022

The Medicare Fee-for-Service Compliance programs prevent, reduce, and measure improper payments in FFS Medicare through medical review. G is the field on the 1500 claim being audited for MUE compliance: These edits are updated at least quarterly and revised in your practice management system through updates to the software.

Medicare 52

Medicare Medicare Compliance Governance 52

Hall Render

AUGUST 26, 2022

Compliance with Oct. Fauci to step down in December to ‘mentor the next generation’ EMTALA covers abortion in Idaho hospitals, judge rules. New rural hospital model draws interest – and questions. Could a hospital be in the Riverchase Galleria’s future? COVID-19 emergencies linger throughout U.S.

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

MARCH 22, 2024

NATIONAL 79 percent have positive outlook for senior living and care: NIC 12 key legal issues impacting health systems AHA: 94% of hospitals financially impacted by Change Healthcare’s cyberattack A conversation about the HHS plan on AI in health care A new kind of hospital is coming to rural America.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Nurses Hospitals 40