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

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

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. For healthcare organizations, understanding UPIC audits and preparing for them is essential to compliance. What is the Purpose of UPIC Audits?

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare IT Today

JUNE 29, 2023

The following is a guest article by Isaac Smith, Billing, Coding, and Reimbursement Specialist at Medcare MSO ASCs are types of medical facilities that are subject to stringent regulations. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Two other appendices apply to ASCs.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

US Department of Health and Human Services 52

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

YouCompli

JULY 26, 2023

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. The audit also identified 1,714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare. million in Medicare fee-for-service payments.

Fraud 52

Fraud Compliance Medicare Medicare 52

YouCompli

MAY 11, 2022

This month’s article looks at physician coding and billing cases. It reflects remarks CJ made at HCCA’s 2022 Compliance Institute. For more insights from the Compliance Institute, download our white paper on how compliance professionals can help healthcare institutions mitigate risk.).

Compliance Officers 52

Compliance Officers Fraud Compliance Medicare 52

YouCompli

JULY 12, 2022

This month’s article looks at telehealth actions. In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. An initial report from the OIG also notes that, “over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic.

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COVID-19 Medicare Medicare Telemedicine 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.

Fraud 52

Fraud Compliance Medicare Medicare 52

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Why this Trend of Value-Based Care?

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Why this Trend of Value-Based Care?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

MAY 12, 2021

The Hidden Benefits of Regulatory Compliance in Healthcare. With its maddening complexities and time- and resource-consuming demands, regulatory compliance is thought to be the plague of any thriving business. However, according to a recent Forbes Magazine article , regulatory compliance is a golden opportunity in disguise.

Regulatory Compliance 40

Regulatory Compliance Compliance HIPAA Medical Personnel 40

HIPAA Journal

OCTOBER 21, 2022

For example, the Administrative Requirements (Part 162) helped reduce insurance fraud and accelerated eligibility inquiries, authorization requests, and claims processing. However, the issue of personal health records deserves its own section in this article because – until recently – the oversight of personal health records has been minimal.

HIPAA 95

HIPAA Compliance Medicare Medicare 95

YouCompli

DECEMBER 7, 2022

These exclusions are generally related to criminal activity like fraud or healthcare-related misconduct. Felony convictions for other healthcare-related fraud, theft, or other financial misconduct. Compliance with these rules sounds like a straightforward process. Don’t miss enforcement action articles from CJ Wolf.

Fraud 52

Fraud US Department of Health and Human Services Compliance Medicaid 52

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. It is arguably more important — and harder — to maintain a standard level of compliance when staff are working in client homes, rather than in a central facility. What is the Role of Home Health Aides?

Compliance 52

Compliance HIPAA Fraud Licensing 52

AIHC

MAY 7, 2024

This article addresses what Chief Financial Officers (CFOs) and other C-Suite executives needs to know about AI efficiencies and revolutionizing your RCM process. Revenue Cycle Management Compliance Revenue cycle management involves complex processes to manage financial transactions related to healthcare services.

Compliance 52

Compliance Compliance Officers Fraud Doctors 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. This is also called “store-and-forward telemedicine.”

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COVID-19 Telemedicine Compliance Informed Consent 59

Medisys Compliance

OCTOBER 20, 2023

This article provides an in-depth overview of emergency medical specialists billing, highlighting common challenges, strategies for accurate and efficient billing, industry updates, and emerging trends. Staying current with industry updates and regulatory changes is vital to ensure compliance and maximize revenue.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Compliance 59

YouCompli

JANUARY 4, 2022

Unger, Chief of Medicaid Fraud Division, Office of the Massachusetts Attorney General; and Patrick Callahan, Healthcare Fraud Unit, US Attorney’s Office. Unger and Callahan addressed the Massachusetts Health and Hospital Association’s Healthcare Legal Compliance Forum in December 2021. Provider workload and compliance.

Fraud 40

Fraud Compliance Elder Abuse Medicaid 40

AIHC

MARCH 2, 2023

Written by: Nancie Lee Cummins , CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This is part 2 in the Leadership essay series from members of the American Institute of Healthcare Compliance (AIHC). The article which was published on AIHC which I reviewed brought in a couple of new perspectives to tools that I could implement.

Compliance Officers 52

Compliance Officers Compliance Fraud Medical Billing 52

Hall Render

FEBRUARY 4, 2022

Of that, $5 billion relates to health care fraud involving drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories and physicians. Health Care Fraud Actions. ” Medicare Part C. ” Medicare Part C. Boynton of the DOJ Civil Division.

Fraud 40

Fraud Governance Medicare Medicare 40

Hall Render

JANUARY 11, 2023

For example, reimbursement under Medicare and Medicaid for certain telemedicine services was significantly increased due to the COVID-19 pandemic. Hall Render blog posts and articles are intended for informational purposes only. Your primary Hall Render contact.

Compliance 40

Compliance HIPAA FDA Due Diligence 40

YouCompli

APRIL 13, 2022

This month’s article looks at beneficiary inducement actions. But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. Deflated Medicare copayment and ‘courtesy adjustments’ for injections.

Medicare 40

Medicare Medicare Governance Compliance 40

Healthcare IT Today

FEBRUARY 2, 2023

The following is a guest article by Rebecca Darnall, R isk Adjustment Leader at Episource. It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. The Justice Department has joined the fraud case against one large national insurer.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Hall Render

NOVEMBER 15, 2023

Billing for Advanced Practice Professionals (“APPs”) has been a challenging area for providers and practitioners because of different and changing Medicare, Medicaid and state law requirements. This standard was interpreted and applied differently by various Medicare contractors and was difficult to review/audit.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Hall Render

FEBRUARY 27, 2023

This has been a growing trend in health care enforcement, and health care fraud remained the leading source of all FCA cases in 2022. Health Care Fraud Actions Medicaid. COVID-10 Related Fraud. Proactive compliance programs are an excellent defense and can help to identify issues before these issues potentially pose FCA risk.

Nursing Homes 40

Nursing Homes Fraud Medicaid Medicaid 40

HIT Consultant

NOVEMBER 24, 2022

– Delivery model : Whether to ship OTC products to a hearing clinic where the consumer can receive professional diagnosis, fitting and support, or ship directly to the consumer’s home thereby providing convenience but no professional support (and increased fraud risk), or offer both options? 4 And compliance decrease over time. .

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FDA Public Health Medicare Medicare 98

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

AIHC

FEBRUARY 16, 2024

Lessons Learned about Consequences & Incentives Submitted by the AIHC Education Department Introduction The Office of Inspector General has released the new General Compliance Program Guidance or “GCPG” in late 2023. One of the seven items, #5 is “Enforcing Standards: Consequences and Incentives.”

Compliance 52

Compliance US Department of Health and Human Services COVID-19 Hospitals 52

Medisys Compliance

APRIL 27, 2022

Another goal was to prevent healthcare fraud. A different argument is that HIPAA compliance builds trust, which gives patients the confidence to reveal details about their health to healthcare professionals, which improves the delivery of healthcare. In this article, we shared few tips to keep your practice HIPAA compliant.

HIPAA 52

HIPAA Medical Billing Outsourcing Medical Billing Ransomware 52

Florida Health Care Law Firm

FEBRUARY 22, 2022

In yet another take-down of an illicit scheme to defraud the Medicare Program and ChampVA, as well as other insurers, Patsy Truglia has been sentenced to 15 years in federal prison. He has also had assets forfeited since these assets were acquired with money from his ill-gotten fraud scheme. genetic testing).

Medicare 52

Medicare Medicare Telemedicine Fraud 52

AIHC

JANUARY 5, 2023

Learn about the 7 steps to Medicare Compliance Medicare is federally regulated and requires healthcare providers to ensure that they comply with the many requirements before being eligible for reimbursement. Applying for Medicare compliance can be a daunting task for healthcare providers. What does this mean?

Medicare 59

Medicare Medicare Compliance Medicaid 59

Med Law Blog

JANUARY 13, 2022

Under the Federal Ethics in Patient Referrals Act (more commonly known as “Stark”), if a physician [1] has a financial relationship with an entity, the physician may not refer patients to the entity for medical services payable by Medicare unless the financial relationship complies with the Stark safe harbors. Please contact Ashley S.

Medicare 40

Medicare Medicare Compliance Medicaid 40

Healthcare Law Blog

MAY 31, 2022

However, traditional healthcare players, subject to the Health Insurance Portability and Accountability Act (“HIPAA”), may also find themselves innovating in this space (and grappling with how to stand up a HIPAA compliance program in the metaverse). 1] “Metaverse may be $800 billion market, next tech platform,” Bloomberg Intelligence (Dec.

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FDA HIPAA Medicare Medicare 90

AIHC

AUGUST 8, 2023

Written by: Carl Byron , CCS, CHA, CIFHA, CMDP, CPC, ICDCT-CM/PCS, OHCC This article follows The Cobra Effect articles Part 1 and Part 2 also written by Carl Byron. I am a Certified Internal Healthcare Fraud Auditor (CIFHA). More than likely some aspect involves a breach of compliance so compliance representatives must attend.

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Compliance Fraud Medicaid Medicaid 52

Hall Render

JULY 12, 2023

If a deemed hospice fails to meet the Medicare requirements or shows continued condition-level noncompliance, deemed status is generally removed and oversight is placed under the SA. Selected hospices either successfully complete the SFP program or are terminated from the Medicare program. of hospice providers reported data.

Medicare 40

Medicare Medicare Nursing Homes Fraud 40