Medisys Compliance

JULY 8, 2024

Introduction Medical billing has evolved significantly over the years, moving from manual processes to sophisticated digital systems. This article explores how these innovations are transforming medical billing practices, offering insights into the benefits and applications for healthcare providers.

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Medisys Compliance

JUNE 23, 2024

Introduction In the ever-evolving landscape of healthcare, compliance with the Health Insurance Portability and Accountability Act (HIPAA) is crucial for protecting patient information and maintaining trust. Enacted in 1996, HIPAA is a federal law designed to safeguard patient health information (PHI) from fraud and abuse.

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Medisys Compliance

JANUARY 16, 2025

While some flexibilities have been made permanent, providers should stay updated on the latest CMS guidelines to ensure compliance. Medicare Provider Enrollment Behavioral health providers must enroll with Medicare to bill for covered services. Avoid upcoding: Ensure billed codes reflect the actual services provided.

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AIHC

JUNE 27, 2023

Written by: Rana Awais Coding, Billing, IT Expert In today's rapidly advancing healthcare landscape, medical billing has become a critical aspect of running a successful medical practice. Efficient and accurate billing processes are essential for healthcare providers to receive timely payments for their services.

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Compliancy Group

FEBRUARY 12, 2024

Fraud in healthcare has run rampant in recent years, as evident by two incidents in which healthcare organizations billed insurance companies for things patients never received. In the other fraud scheme, Medicare patients were billed an estimated $2 billion for urinary catheters they never received. Attorney Philip R.

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Medisys Compliance

JANUARY 17, 2023

If you’ve ever questioned about outsourcing your medical billing, this article will go through all the benefits it offers you in terms of operations, and all the reasons to outsource medical billing. Now, let’s consider the factors to consider when outsourcing Behavioral Health medical billing: 1.

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Medisys Compliance

JANUARY 30, 2023

The medical billing industry is a complex and ever-changing field, and it is crucial for healthcare providers and billing companies to stay compliant with government regulations. State Laws: In addition to federal laws, medical billing companies and healthcare providers must also comply with state laws and regulations.

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AIHC

SEPTEMBER 3, 2024

Celebrating the Healthcare Compliance Officer The American Institute of Healthcare Compliance is recognizing healthcare Compliance Officers – hats off to you! The primary goal of a compliance officer is to mitigate risk. This involves investigating complaints and conducting internal auditing and monitoring for compliance.

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Healthcare Compliance Blog

APRIL 12, 2022

To minimize fraud in payroll, it is recommended that payroll steps be broken up between at least two individuals so that no one person is responsible for deductions, payroll processing, disbursement, and distribution of payroll. Violations of payroll management can be considered fraud and can result in fines and imprisonment.

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Medisys Compliance

NOVEMBER 6, 2023

Introduction Orthopedic billing compliance is essential for healthcare providers to avoid costly audits and penalties. By following a comprehensive orthopedic billing compliance checklist, providers can ensure that their claims are accurate, complete, and supported by proper documentation.

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Medisys Compliance

SEPTEMBER 9, 2022

Medical billing errors are simple to make but have a significant impact on the overall revenue of the healthcare organization. Optometry medical billers deal with a variety of problems, including returned claims, denied claims, rejected invoices, improper coding, and insufficient data. Using medical coding manual .

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MedTrainer

MARCH 8, 2024

Employee compliance training is essential to any healthcare organization’s onboarding process. This blog post will explore why compliance training is vital for an industry where mistakes or non-compliance can seriously affect patients, staff, and the organization.

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Medisys Compliance

NOVEMBER 26, 2024

Skilled Nursing Facility (SNF) billing compliance is a critical aspect of healthcare revenue cycle management, ensuring accurate reimbursement and adherence to Medicare regulations. As healthcare providers navigate the complexities of SNF billing, maintaining compliance is essential to avoid penalties, denials, and financial losses.

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Healthcare Law Blog

NOVEMBER 9, 2023

In late April this year, the Office of Inspector General, Department of Health and Human Services (OIG) announced that it would make changes to its existing body of healthcare compliance program guidance (CPGs) as part of its current Modernization Initiative. [1] On November 6, 2023, OIG finally published the GCPG on its website [3].

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Physician Credentialing Company

JANUARY 6, 2025

CPT codes hold a significant place in medical billing and coding. All patient care services, i.e., diagnostic, therapeutic, or management services, are represented by their specific codes in the medical bills. In this article, we will learn the description of CPT code 93970 and the medical indications of its use.

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AIHC

JUNE 6, 2023

However, they are notoriously bad at context and nuance – two things critical for safe and effective patient care, which requires the implementation of medical knowledge, concepts, and principles in real-world settings.” AI can also be used for medical billing denial management to reduce the risk of denied claims and increase revenue.

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MedTrainer

JANUARY 26, 2024

Non-compliance in healthcare refers to the failure of healthcare providers, institutions, or individuals to adhere to the laws, regulations, and standards established to protect patient welfare, maintain data security, and ensure the efficient and ethical delivery of healthcare services. What is Healthcare Compliance?

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Healthcare IT Today

JULY 30, 2024

Revenue Cycle Management (RCM): The Strongest Use Case of GenAI in Healthcare The financial backbone of healthcare, RCM, entails everything from payments and pre-authorization before treatment to reimbursements, compliances, and interoperability with other systems.

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MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Their duties span across several areas, from ensuring adherence to laws to navigating the complexities of medical billing protocols. What Is the Primary Role of a Compliance Officer in Healthcare?

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AIHC

JUNE 6, 2023

However, they are notoriously bad at context and nuance – two things critical for safe and effective patient care, which requires the implementation of medical knowledge, concepts, and principles in real-world settings.” AI can also be used for medical billing denial management to reduce the risk of denied claims and increase revenue.

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Medisys Compliance

OCTOBER 20, 2023

Emergency medical billing is a critical component of healthcare services, playing a pivotal role in ensuring that healthcare providers are adequately compensated for their life-saving efforts. Detailed medical records provide the necessary support for justifying the level of care and ensuring appropriate reimbursement.

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Healthicity

AUGUST 13, 2024

However, ASCs are not immune to compliance issues. Physicians often like them because they hold potential for increased efficiencies over a traditional hospital-based operating room. Patients often like them because they are in and out within a day, which makes scheduling and completion of procedures more convenient.

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Healthicity

JUNE 7, 2022

How to Combat Fraud and Abuse When Working With (Or For) A Third-Party Billing Company.

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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.

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Compliancy Group

FEBRUARY 7, 2024

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. Who Should Be Concerned About CMS UPIC Audits?

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AIHC

MAY 31, 2022

health care system relies heavily on third-party payers to pay the majority of medical bills on behalf of patients. Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. First, remember that anyone can commit health care fraud.

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Medisys Compliance

JULY 13, 2022

Outsourcing your medical billing and coding operations to a revenue cycle company like Medisys Data Solutions can solve lot of staffing problems. To tackle this challenge healthcare financial leaders should shift their mindsets and think about medical billing vendors as their partners in growth.

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Medisys Compliance

FEBRUARY 27, 2023

Challenges of Wound Care Billing Wound care billing can be a complex and challenging process due to several factors including, coding complexity, documentation requirements, reimbursement limitations, billing multiple payers, and risk of fraud & abuse billing. Strategies of Improving Wound Care Billing 1.

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Medisys Compliance

AUGUST 21, 2024

In 2024, the Centers for Medicare & Medicaid Services (CMS) introduced several crucial updates to radiation oncology billing guidelines. These changes affect coding, reimbursement, and compliance requirements, making it essential for providers to stay informed to maximize reimbursement and avoid penalties.

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Medisys Compliance

NOVEMBER 23, 2023

Review modifier usage regularly: Regularly audit modifier usage to identify any inconsistencies or errors and ensure compliance with payer guidelines. Duplicate Billing Duplicate billing , the inadvertent billing for the same service multiple times, can result in claim denials and potential fraud investigations.

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Medisys Compliance

APRIL 29, 2022

Truth be told, these are usually just innocuous mistakes that do not represent any intent to commit billing fraud but the auditors don’t see it that way. They don’t know if you forgot to revise that review of systems because you’re up until 11:30 pm signing off on your notes, or if you’re trying to pad the record with billing elements.

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YouCompli

OCTOBER 17, 2023

In part, the statement said the practice “…cooperated completely with the investigation, which involved examining the billing company that was responsible for their medical coding and billing…Unfortunately, medical billing is so complicated that physicians must rely on their medical billers to accurately reflect and bill for their services.”

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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. Your RCM team must be trained properly on ways how to process, transfer the data.

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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). I do a lot of training of compliance officers and realize the time that is being spent could be improved.

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Medisys Compliance

MARCH 7, 2022

These are usually just innocuous mistakes that do not represent any intent to commit billing fraud. signing off on your notes or if you’re trying to pad the record with billing elements. Medisys Data Solutions is a leading medical billing company providing complete medical billing and coding services.

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MedTrainer

JULY 21, 2022

However, unauthorized access is causing more than just identity fraud. Hackers stole medical billing records from a whopping one million New York patients—that’s about an eighth of the city’s total population. Since 2020, approximately 113 million people have been impacted by healthcare data breaches.

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Physician Credentialing Company

JULY 15, 2024

This involves checking education, training, licensure, and professional experience to ensure compliance with legal and professional standards. It not only supports compliance with regulations but also enhances the credibility of healthcare facilities. This process reduces the risk of fraud and ensures accuracy.

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