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This approach enhances both performance and compliance while minimizing human error. According to a Black Book survey , 90% of HIM professionals believe that upcoding is a significant ethical concern, while 85% say that discrepancies identified during coding audits often lead to denied claims or repayment demands due to system complexity.
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
As we wrap up another year and get ready for 2025 to begin, it is once again time for everyone’s favorite annual tradition of Health IT Predictions! Check out the community’s predictions down below and be sure to follow along as we share more 2025 Health IT Predictions !
Technologies continue to transform the healthcare industrythe da Vinci Surgical Robot performs precise movements that enable minimally invasive surgeries, the CyberKnife delivers targeted radiotherapy, and smart devices provide practitioners with instantaneous updates to patient health. What Is AI in Healthcare Compliance?
A registered nurse from a veteran’s hospital in Detroit pleaded guilty to charges related to COVID-19 vaccination record cards fraud. Issue: Legitimate vaccination cards are being stolen from healthcare facilities and then used in a fraudulent manner. Participating in the fraud can result in the person(s) being prosecuted.
An acute care hospital in Oklahoma has paid over $1.1 Following an internal review and audit, the hospital discovered irregularities regarding its billing of certain services, and proactively contacted the United States to self-disclose the issues.? Throughout the investigation, the hospital cooperated with the above entities.
A comprehensive hospital compliance work plan is pivotal for achieving these objectives. Hospital compliance officers, c-suite executives, and other decision-makers must constantly stay abreast of the latest developments in healthcare compliance. What Are Hospital Compliance Work Plans?
The onboarding process is pivotal in ensuring employees understand their job duties, engage in best cybersecurity practices, and comply with important regulations like the Health Insurance Portability and Accountability Act, Occupational Health and Safety Administration, and prevention of Fraud, Waste, and Abuse in healthcare.
Do your hiring managers and Human Resources colleagues know what to look for? Department of Health and HumanServices Office of Inspector General (OIG) has the authority to exclude individuals and entities from federally funded healthcare programs. Provision of unnecessary or substandard services.
These hackers are costing health organizations millions of dollars and threatening the safety of patients. However, unauthorized access is causing more than just identity fraud. In January of 2018, Hancock Health of Indiana experienced a serious ransomware attack that forced their entire network to shut down.
Because care requires using and exchanging sensitive patient information, adherence to U.S. When personal health information transcends international borders, vendors outside the U.S. When unauthorized parties gain access to this information, identity theft, fraud, and diminished care often result. law extends to you.
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.
Federal payments for healthcare services account for 28% of all healthcare spending in the United States. The List of Excluded Individuals/Entities (LEIE) is maintained by the Department of Health and HumanServices (HHS) Office of the Inspector General ( OIG) and dictates which providers are excluded from receiving federal funds.
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.
Hospitals and private practices aren’t the only enterprises with compliance obligations within this sector. Insurance carriers, cloud service providers, pharmacies, medical equipment manufacturers, and other organizations in this industry must comply with various health and safety regulations. No other industry in the U.S.
Whether you use paper, spreadsheets, email, or fax, the credentialing process can be long and frustrating when you’re doing it internally. It’s important for a practitioner to be credentialed and have privileges granted before beginning to practice medicine and bill for services rendered. What’s the solution?
As government agencies and national regulatory organizations pass more regulations and the need for healthcare services grows, healthcare compliance officers (HCOs) are more important than ever. Healthcare entities must comply with an increasingly complex and changing set of laws and regulations. HCO Qualifications. Reimbursement.
Traditional Medicare is administered by the federal government, and individuals pay a separate monthly premium for hospital visits, doctors/outpatient, and prescription drugs. In contrast, Medicare Advantage is provided through a private health plan and typically covers everything in one monthly premium.
Once the validity of a physician has been checked, hospitals will know that the candidate has the right experience to perform in their position. . Should a hospital hire an inexperienced or excluded individual, they place the wellbeing of their patients in jeopardy, and put their institution at risk for being non-compliant.
Once the validity of a physician has been checked, hospitals will know that the candidate has the right experience to perform in their position. . Should a hospital hire an inexperienced or excluded individual, they place the wellbeing of their patients in jeopardy, and put their institution at risk for being non-compliant.
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.
It supports compliance with laws like the Health Care Quality Improvement Act and standards set by accrediting bodies such as The Joint Commission. Imagine walking into a hospital and seeing credentials proudly displayed. Effective nurse credentialing systems facilitate smoother audits and simplify reporting to regulatory agencies.
Explore the full article to gain a holistic understanding of the law or use the table of contents below to find the specific information you need. Your HIPAA compliance plan will change as your staff, IT department, and business grows or evolves. HIPAA” is the Health Insurance Portability and Accountability Act of 1996.
The Department of Health and HumanServices once again (for the ninth time) extended the public health emergency this past month , stretching it beyond mid-July. But sooner or later, that provision of the Public HealthService Act will draw to a close. We spoke recently with Allison M.
Many businesses and organizations came to an abrupt halt as all systems using CrowdStrike received the infamous blue screen of death. Richard Bird, Chief Security Officer at Traceable AI The CrowdStrike event serves as an incredibly important reminder that the digital world is nothing more than a tool that serves the human world.
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.” The result?
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.” The result?
To stay in compliance with federal and state regulations and to keep patients safe, it’s vital for hospitals and health systems to monitor the licenses of their practitioners for new information that may prevent a physician from practicing. How does a healthcare facility find all of these adverse actions? Professional Affiliations.
The following is a guest article by Rachel Podczervinski MS, RHIA, Vice President of Professional Services at Harris Data Integrity Solutions. House and Senate Labor, Health and HumanServices, Education, and Related Agencies (Labor-HHS) appropriations bills. million per year in denied claims and lost revenue.
News ranks hospitals in health equity. These hospitals earn top honors. These hospitals earn top honors. facility Southern Research CEO talks biotech incubator, future of Birmingham medicine ALASKA Juneau’s hospital is bleeding cash. list includes 3 from Arizona ARKANSAS Children’s Miracle Network Raises $5.4M
Homer hospital bond ARIZONA After 24 years as CEO of Banner, Peter Fine pinpoints the most important traits for leaders Banner’s momentum blueprint Doctors speak out as U.S. NATIONAL 50% of U.S. to buy property. NATIONAL 50% of U.S. to buy property. NATIONAL 50% of U.S. to buy property. Kenai Peninsula Borough Assembly considers $38.5M
NATIONAL 10 multimillion-dollar Stark law cases in 2 years 40 hospital ownership changes made in 1 day 15 Areas That Would Change Under Health Data Rule Proposal 5 states cracking down on noncompetes New DOJ whistleblower program not ‘easy money’: legal expert CMS’ inpatient rule adds ‘insult to injury,’ say hospital groups CMS drops (..)
Vincent North in Sherwood Washington Regional Medical System Names Lucas Campbell as VP & Chief Transformation Officer 4 more Arkansas hospitals awarded federal funds Arkansas Legislative Council approves Department of HumanServices’ requests for $13.4M Opens in North Little Rock CHI St.
NATIONAL 50% of physicians are thinking of leaving the field due to shortage AHA backs bid to repeal nursing home staffing rule AHA wins lawsuit against HHS over third-party web tracking AHA responds to study blaming hospital prices for societal issues AHA slams study tying unemployment to hospital price increases Behind the battle against corporate (..)
in Refinancing for Medical Office Building in Goodyear, Arizona Northern Arizona VA part of national campaign to help veterans with ‘blast exposure’ become eligible for benefits Pharmaceutical company now profits off Arizona opioid crisis settlement Scottsdale hospital performs breakthrough heart procedure with new technology St.
NATIONAL 80 hospitals sue HHS over Medicare Advantage Days payment rule AHA op-ed in Medical Economics sets the record straight on 340B program growth and the role of drug companies As hospitals close obstetric units, maternity care deserts become more common At Catholic hospitals, a mission of charity runs up against high care costs for patients Bill (..)
NATIONAL AHA Comments on CMS’ Inpatient Payment Proposal for FY 2025 AHA urges CMS to make Transforming Episode Accountability Model voluntary AMA adopts new policy to create equity in clinical trials and research DOJ loses bid to toss Humana Medicare Advantage case Drug shortages hit highest number since 2001, impacting patients, hospitals and pharmacies (..)
NATIONAL 4 largest healthcare data breaches of 2023 Anesthesia practices sue CMS over reimbursement method Antitrust enforcements hit a high in 2022, with health deals impacted ASCs face leadership exodus CMS floats appeals process over observational stays CMS proposes additional Medicare appeals processes FTC eyes healthcare mergers, report shows (..)
in 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing? in 2022, survey finds Senate votes to end COVID-19 national emergency Why are 600+ rural hospitals at risk of closing? What happens if it disappears?
million for rural hospital expansion Hospices in Arizona & other states receive scrutiny over concerns of fraud, waste & abuse Phoenix Children’s Building New 44,000-Square Foot Level IV Neonatal Intensive Care Unit Firefighters oppose Banner’s planned $400M hospital There’s a growing nurse shortage in Arizona.
The CDC has stopped printing them Telehealth Visits Decline 46%, But Telebehavioral Healthcare Still High URAC to offer health equity accreditation Walgreens CIO is latest to leave in company’s C-suite shakeup AI is creating a complex landscape for healthcare executives ALABAMA Alabama hospital to remain on Cerner after sale Alabama gets $3.6M
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