MedTrainer

APRIL 16, 2024

Healthcare compliance auditing software helps compliance managers prepare their organization for an audit. As the regulatory landscape evolves, having robust healthcare compliance software to ensure you’re audit-ready will become increasingly important for compliance officers in 2024.

Compliance 52

Compliance Compliance Officers Regulatory Compliance Governance 52

Healthcare IT Today

JANUARY 17, 2024

healthcare organizations, which analyzes auditing, charge analysis, and denial assessment data from MDaudit’s network of more than 650,000 providers and 2,200 facilities. Insights are also from auditing professional and hospital claims totaling more than $5 billion and denials from commercial and government payors exceeding $150 billion.

Compliance 104

Compliance Overpayments Overpayment Medicare 104

Healthicity

MARCH 2, 2023

Has creating custom checklists been on your to-do list for a while? Consider it done.

52

52

HIT Consultant

APRIL 17, 2024

What You Should Know: Wolters Kluwer Health , a leading provider of healthcare information and analytics, has introduced a new weapon in the fight against potential financial penalties for Medicare Advantage Organizations (MAOs) – the Regulatory Audit Module. The Centers for Medicare & Medicaid Services (CMS) estimates a staggering $4.7

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

APRIL 30, 2024

Co-founded by Trey Holterman, Diego Baugh, and Tyler Johnson, Tennr enables healthcare organizations to automate referral processing, payment posting, claims auditing, medical record management, and more. It cleans up the data coming in from faxes to automate patient intake and insurance communications.

Records Management 87

Records Management 87

MedTrainer

APRIL 8, 2024

One effective tool to achieve this is through internal healthcare compliance audits. This article will delve into the significance of internal healthcare compliance audits, the legal and regulatory requirements, the benefits they offer, and the steps involved in conducting such audits.

Compliance 52

Compliance Governance ACA HIPAA 52

MRO Compliance

MARCH 28, 2022

Follow the (Medical) Record: Dawn Crump on Audits and Denials. In this episode, host Don Hardwick interviews Dawn Crump, Senior Director Revenue Cycle Solutions at MRO about healthcare claim denials, and strategies for properly managing audits and denials within a health system setting.

130

130

Healthcare IT Today

DECEMBER 7, 2023

” Based in Toronto , Semantic Health has made significant strides in streamlining manual auditing processes, reducing denials, and improving documentation quality for auditing teams. This will help us improve data quality, optimize revenue cycle management (RCM) efficiency, and unlock generative AI in healthcare.”

Compliance Officers 93

Compliance Officers Health Insurance Hospitals Compliance 93

Healthcare IT News - Telehealth

JANUARY 30, 2023

The Australian National Audit Office has conducted a review of the expansion of telehealth services across the country by the Department of Health and Aged Care in response to the COVID-19 pandemic. FINDINGS Based on the state audit , the department fell short in governance, risk management, and evaluation of the telehealth expansion.

COVID-19 148

COVID-19 Governance Medicare Medicare 148

Verisys

JANUARY 8, 2024

A healthcare compliance audit is a thorough review and examination of an organization’s adherence to regulatory guidelines. This type of audit is essential in the healthcare industry for several reasons: Regulatory Compliance It ensures that the healthcare organization complies with various federal and state laws and regulations.

Compliance 52

Compliance Regulatory Compliance Health Insurance Medicaid 52

MRO Compliance

MARCH 2, 2022

Compliance officers and auditors today are tasked with responsibility for monitoring and auditing hundreds of rules and regulations that impact healthcare. More than ever before, a team-based approach is needed to manage the burden and ensure regulatory compliance.

Compliance 130

Compliance Regulatory Compliance Compliance Officers Hospitals 130

Innovaare Compliance

DECEMBER 25, 2023

Summary of the HPMS Memo Generated by USHER (Inovaare’s AI-powered Compliance Assistant) The Centers for Medicare and Medicaid Services (CMS) issued a memorandum detailing several announcements relating to its 2024 CMS program audit. CMS plans both routine and focused audits for 2024 to verify compliance with these new regulations.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

MedTrainer

APRIL 22, 2024

Creating and using a supplier compliance checklist ensures vendors meet regulatory requirements and are trusted partners in managing sensitive information. Our supplier compliance checklist will help guide you through vendor audits and how to ensure you’ve chosen the right partners for your organization.

Compliance 52

Compliance HIPAA Licensing Fraud 52

Healthcare It News

JULY 11, 2022

The survey, which was conducted in June, gathered responses mostly from facility managers (37%), followed by nursing directors (20%), CEOs (13%) and care managers (7%). WHY IT MATTERS. "These results are concerning," remarked Arthur Shih, CEO of Humanetix, one of the founding members of the ACTC. He said there is "??no

Health Outcomes 215

Health Outcomes Nurses Compliance 215

Compliancy Group

JANUARY 22, 2024

This is where a healthcare audit – conducting a thorough investigation into operations, processes, and practices – comes in. So grab your magnifying glass and join us as we unveil the crucial components of a healthcare audit checklist. Its mission? To uncover areas of risk and implement corrective action plans.

Compliance 52

Compliance Fraud Regulatory Compliance HIPAA 52

Healthcare IT Today

APRIL 11, 2024

Start with a Secure Foundation & Build a Robust Cloud Infrastructure for Your CMS One common misconception from legacy healthcare IT is that in-house hosting is inherently more secure and offers a superior performance due to its dedicated organizational management.

Compliance 92

Compliance Health Insurance HIPAA 92

Medisys Compliance

DECEMBER 1, 2023

Introduction Wound care plays a pivotal role in managing and treating a wide spectrum of injuries, from acute wounds to chronic ulcers. This is where wound care coding audits come into play, serving as a critical tool for healthcare providers to identify and rectify errors, maintain compliance, and optimize revenue capture.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medical Billing Services 59

HIPAA Journal

JANUARY 11, 2024

The Background to the Office of Inspector General The Office of Inspector General for the Department of Health, Education, and Welfare (as the HHS OIG was known as at the time) was created in 1976 to “supervise, coordinate, and provide policy direction for auditing and investigative activities relating to programs and operations of the Department”.

Fraud 86

Fraud HIPAA Compliance Medicare 86

Compliancy Group

NOVEMBER 22, 2023

One way to demonstrate this commitment is by undergoing a SOC 2 audit. A SOC 2 audit is an independent assessment of an organization’s internal controls and processes related to security, availability, processing integrity, confidentiality, and privacy. Let’s take a closer look at each stage. Schedule Now × Get a Demo!

Compliance 52

Compliance 52

Healthcare IT Today

NOVEMBER 22, 2022

The number of Medicare TPEs and commercial payer take-back audits alone is skyrocketing. It’s important to know what types of audits exist, what to be aware of, and how productivity goals can affect clinics and culture. . Understand the Different Types of Audits. Not all audits are created equally.

Medicare 94

Medicare Medicare Overpayments Overpayment 94

HIPAA Journal

APRIL 19, 2024

Increased Visibility: Compliance software provides real-time visibility into compliance activities including incident management, allowing the chief compliance officer to monitor progress, track key metrics, and identify areas that require attention. For a chief compliance officer the benefits of using healthcare compliance software are: 1.

Compliance 52

Compliance Compliance Officers Regulatory Compliance HIPAA 52

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.

Compliance 59

Compliance Medical Billing Outsourcing Medicare Medicare 59

MRO Compliance

JUNE 1, 2022

Information You Need to Know about a HEDIS Audit from Revenue Cycle Experts. Each year HEDIS rating criteria is updated, meaning your organization needs to stay up-to-date on the latest news and trends for HEDIS compliance audits. What is a HEDIS audit? How does the HEDIS audit process work? Data integrity.

Medicare 130

Medicare Medicare Compliance Medicaid 130

Healthcare Blog

JUNE 13, 2023

Healthcare policy management software is essential for healthcare providers and organizations to stay up-to-date with the latest compliance requirements. A healthcare policy management solution can help your employees remain compliant and decrease incidents that result in costly penalties.

Compliance 101

Compliance 101

Healthicity

AUGUST 11, 2023

We thought you might be, which is why we expanded our Audit Manager training library ! Are you in need of a comprehensive training library with easy employee assignments and tracking?

52

52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. CMS also stated in the final rule that it will not apply a Fee-For-Service (FFS) Adjuster in its RADV audits.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Compliancy Group

FEBRUARY 28, 2024

CMS guidance requires Medicare Advantage Plans to independently audit their compliance program’s effectiveness. These audits should occur once per year. CMS Compliance Audits Compliance with CMS requirements is critical to healthcare delivery, particularly for organizations that participate in Medicare, Medicaid, or CHIP programs.

Compliance 52

Compliance US Department of Health and Human Services Fraud Medicare 52

Innovaare Compliance

JANUARY 19, 2024

An overview of the routine program audits was updated in December 2023 and is available on the CMS website. [1] 1] Focused audits will be limited in scope and duration and will only test the Compliance Program Effectiveness (CPE) and Organization Determinations, Appeals, and Grievances (ODAG) program areas during focused audits.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Healthcare IT Today

MARCH 11, 2024

As the industry navigates this perilous digital terrain, understanding, managing, and effectively integrating cyber insurance into its risk management strategies has never been more critical. Instead, risk management plans must be custom fit for healthtech to navigate the ever-changing digital landscape. Let’s dive in.

Ransomware 110

Ransomware Hospitals 110

Healthcare IT Today

FEBRUARY 9, 2024

With generative AI use cases on the rise across the healthcare landscape, this turbocharged form of AI is now poised to automate untouched terrain in the realm of payment integrity, starting with the automation of highly complex healthcare claim audits. Automation of these complex audits drives exponential process efficiencies and outcomes.

Fraud 108

Fraud Governance Hospitals Licensing 108

HealthStream

MAY 23, 2019

A comprehensive coding audit requires thoughtful preparation, including identifying its goals and scope, in order to achieve the desired results.

40

40

HIT Consultant

NOVEMBER 16, 2023

What You Should Know: – AAPC , a leading global solutions provider in healthcare revenue cycle management, has acquired Semantic Health , an early-stage healthcare technology company focused on creating AI-powered inpatient medical auditing software for health insurance plans and hospitals.

Health Insurance 52

Health Insurance Hospitals 52

Healthcare IT Today

APRIL 9, 2024

CodaMetrix , the leading artificial intelligence (AI) solution for transforming healthcare and revenue cycle management, today announced that it has closed its $40 million Series B funding round. Todd Cozzens, Co-Founder and Managing Partner at Transformation Capital, will join CodaMetrix’s Board of Directors.

Compliance 112

Compliance Doctors Hospitals 112

Innovaare Compliance

DECEMBER 14, 2023

These developments underscore the importance of proactive compliance monitoring and the serious implications, including the heightened possibility of being exposed to RADV Audits for failing to adhere to regulatory standards. The post Medicare Advantage Overpayments: Are You Ready for RADV Audits? appeared first on Inovaare.

Overpayments 52

Overpayments Overpayment Medicare Medicare 52

Compliancy Group

FEBRUARY 7, 2024

You may have been hearing about UPIC (Unified Program Integrity Contractor) audits more often lately. CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary.

Fraud 52

Fraud Compliance Medicare Medicare 52

Healthcare IT Today

FEBRUARY 2, 2023

You don’t have to be a fortune teller to see the future of auditing at the Office of Inspector General (or OIG). To that end, the agency doubled its budget for audits in 2022. The clear message is to expect — and prepare for — more audits. The risk of audits is a legitimate threat to all payer organizations.

Medicare 58

Medicare Medicare Medicaid Medicaid 58

Compliancy Group

MARCH 26, 2024

In addition to ensuring their organization’s adherence to regulations and overseeing a compliance program, compliance officers must also perform comprehensive risk management. However, the most efficient compliance officers know the tools and resources to make this role more manageable.

Compliance 52

Compliance Compliance Officers Regulatory Compliance Hospitals 52