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Red Flag Rules in Healthcare: What Compliance Officers Need to Know

Compliancy Group

For example, some medical identity thieves take insurance information and make fraudulent claims to Medicare or Medicaid for services or goods. Identity theft can also result in the entry of false data into electronic medical records (EMRs) or the creation of fictitious EMRs in victims names.

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Important Resources to Ensure Medicare Compliance

Compliancy Group

depend on Medicare to get the healthcare they need. Remaining in good standing with Medicare has several advantages. Compliance Program A comprehensive way to avoid Medicare exclusion is to develop an organization-wide compliance program, one of the Centers for Medicare and Medicaid Services (CMS) requirements.

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Webinar Recap: Elevate Your Referring and Ordering Physician Monitoring

Provider Trust

Continuous compliance begins with automated monitoring, cross-departmental communication, and population-specific workflow. In a recent webinar , ProviderTrust Founder Michael Rosen and Chief Compliance Officer Donna Thiel detailed ways in which your organization can effectively monitor your unique provider populations.

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2024 OIG General Compliance Program Guidance

Compliancy Group

In November, updates for 2024 appeared in the OIG General Compliance Program Guidance, including recommendations for Medicare, nursing facilities, and other industry-specific entities. Compliance officers have access to more information about their responsibilities and roles.

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Part 3: Audit Documentation to Avoid Potential Appeal Consequences

AIHC

Providers may take documentation “short cuts” or feel overwhelmed with implementation of a new EMR (electronic medical record) system and clone or make documentation errors. It can result in a situation where insurance opens an investigation or decides to initiate periodic audits on your claims and records.

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