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?

Compliance 52

Compliance Informed Consent HIPAA Medical Billing 52

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.

Compliance 59

Compliance Medical Billing Outsourcing Medical Billing ACA 59

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?

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

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.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

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.

Compliance 59

Compliance Medical Billing HIPAA Due Diligence 59

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?

Fraud 52

Fraud Compliance Medicare Medicare 52

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.

Compliance 52

Compliance Medical Billing HIPAA Due Diligence 52

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.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Compliance 59

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.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

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.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Fraud 59

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.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

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.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Patient Satisfaction Fraud 52

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.”

COVID-19 52

COVID-19 Compliance Fraud Doctors 52

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.

Medical Billing 52

Medical Billing Medical Billing Outsourcing COVID-19 Fraud 52

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.

Compliance Officers 52

Compliance Officers Compliance Fraud Medical Billing 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. Your RCM team must be trained properly on ways how to process, transfer the data.

HIPAA 52

HIPAA Medical Billing Outsourcing Medical Billing Ransomware 52

Healthicity

JUNE 7, 2022

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

Fraud 98

Fraud Medical Billing Compliance 98

Medisys Compliance

APRIL 19, 2023

These requirements include licensure and accreditation, enrollment in Medicaid, compliance with state and federal regulations, participation in quality assurance activities, and maintenance of accurate records of services provided. Providers must cooperate with these initiatives and provide complete and accurate information when requested.

Medicaid 52

Medicaid Medicaid Medical Billing Outsourcing Licensing 52

MedTrainer

AUGUST 8, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40

MedTrainer

FEBRUARY 13, 2022

The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud.

US Department of Health and Human Services 40

US Department of Health and Human Services Medical Billing Hospitals Compliance 40

Florida Health Care Law Firm

DECEMBER 9, 2021

The Rule does not apply to people with coverage through Medicare, Medicaid, Indian Health Services, Veteran Affairs Health Care or TRICARE as these programs already contain protections against high medical bills. Bans balance billing for emergency services.

Medical Billing 40

Medical Billing Medicare Medicare Compliance 40

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 .

Medical Billing 98

Medical Billing Medical Billing Outsourcing Doctors Fraud 98

Medisys Compliance

OCTOBER 31, 2023

Medical billing and coding are critical components of the healthcare industry, ensuring that healthcare providers are reimbursed for their services accurately and efficiently. For those specializing in internal medicine, understanding the basics of internal medicine billing is essential.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Compliance Medicaid 59

Healthicity

JANUARY 31, 2024

Uncover the details behind a $2 million billing settlement as we dissect specific codes, billing patterns, modifiers, and medical necessity issues.

Governance 52

Governance Medical Billing Fraud Compliance 52

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.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Fraud Medical Billing Services 52

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.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Overpayments Overpayment 52

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.

US Department of Health and Human Services 52

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

Healthcare IT Today

SEPTEMBER 19, 2023

Eden Avraham-Katz, VP of Legal & Compliance at 1upHealth While I appreciate the efforts to simplify the prior authorization process with FHIR APIs, the underlying issues with prior authorization are fundamentally systemic.

Hospitals 126

Hospitals Nurses HIPAA Governance 126

Hall Render

MAY 19, 2023

SOUTH CAROLINA Grand Strand hospitals hope to see positive impact from Certificate of Need repeal McMaster signs South Carolina’s certificate of need repeal Newly-passed bill allows MUSC to move forward with delayed Nexton Hospital build Prisma Health records $31.7M million to strengthen healthcare in WV Top Doctors Named Across W.Va.

Nurses 40

Nurses COVID-19 Hospitals Nursing Homes 40

Hall Render

MARCH 3, 2023

Clair Health partners with Duquesne University College of Osteopathic Medicine UPMC sees lower operating income in 2022 as economic headwinds persist UPMC settles lawsuit with federal government for $8.5

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40

Hall Render

AUGUST 19, 2022

Stockton Doctor and Medical Practice Agree to Pay Nearly $2 Million to Resolve Allegations of Health Care Fraud. New Colorado Mountain Medical program helps employees grow into health care industry. Collapse of private equity-backed Missouri hospitals mired employees in medical bills.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Hall Render

FEBRUARY 18, 2022

Only 14% of Hospitals Met Price Transparency Rule Compliance. Florida physician convicted of $110M fraud. Lawmaker: Revisions coming to Georgia mental health bill. Local hospitals begin enforcing medical worker vaccine mandates. Family shocked after receiving medical bill that cost more than double what they expected.

COVID-19 40

COVID-19 Nursing Homes Nurses COVID-19 Vaccine 40

Hall Render

MARCH 8, 2024

Bernards ends talks with United Healthcare Brandi Stewart Named Chief Nurse for Baptist Health in Fort Smith, Van Buren A closer look at Arkansas Children’s Hospital expansion CALIFORNIA Adventist Health to buy Tenet Healthcare’s Central Coast hospitals for $550 million California nurses use billboard to voice opposition to hospital sale (..)

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

OCTOBER 20, 2023

We want to know. 1 start as federal regulators give final OK Pfizer to cut costs by $3.5B. 1 start as federal regulators give final OK Pfizer to cut costs by $3.5B.

COVID-19 Vaccine 40

COVID-19 Vaccine Nursing Homes COVID-19 Nurses 40

Hall Render

FEBRUARY 16, 2024

Two medical groups move to reopen it California bill would enable community colleges to offer BSNs California medical office building evacuated following equipment fire Cedars-Sinai’s Priselac Announces Retirement Eskaton downsizes amid $13.6

US Department of Health and Human Services 40

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