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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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. Emerging Trends in Emergency Medical Billing The landscape of emergency medical billing is ever-evolving.

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Medical Billing Medical Billing Outsourcing Medical Billing Services Compliance 59

HIPAA Journal

AUGUST 14, 2023

VUMC provided the medical records of transgender patients to AG Skrmetti after receiving civil investigative demands for the data as part of an investigation into potential medical billing fraud. The medical record disclosures have been condemned by many members of the LGBTQ+ community.

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Medical Billing HIPAA Fraud Doctors 75

HIPAA Journal

JULY 25, 2023

Vanderbilt University Medical Center (VUMC) in Nashville, TN, has confirmed that the medical records of transgender patients have been provided to Tennessee Attorney General, Jonathan Skrmetti, in connection with an investigation of medical billing fraud.

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Fraud HIPAA Medical Billing Doctors 71

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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Medical Billing Medical Billing Outsourcing COVID-19 Fraud 52

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

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Fraud Compliance Medicare 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.

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Medical Billing Medical Billing Outsourcing Patient Satisfaction Fraud 52

Kaiser Health News

APRIL 16, 2024

She ended up with a higher-deductible plan along with medical bills for her now-uninsured son, the lawsuit alleges. “Unfortunately, there’s so much fraud that legitimate agents who are really trying to help people are also being pushed out.” Her actual agent also lost the commission.

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ACA Health Insurance Governance Medical Billing 138

MedTrainer

MARCH 8, 2024

There are three key fundamentals of team member compliance training: It Helps Reduce Risk It Ensures Patient Safety It Fosters a Culture of Compliance Employee Compliance Training Topics Compliance training covers a wide range of topics, including patient privacy, medical billing and coding, workplace safety, and infection control, among others.

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Compliance Fraud Governance HIPAA 52

Medisys Compliance

NOVEMBER 23, 2023

Duplicate Billing Duplicate billing , the inadvertent billing for the same service multiple times, can result in claim denials and potential fraud investigations. With Medisys as your trusted partner, radiologists can confidently navigate the complexities of radiology billing and achieve their financial goals.

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Medical Billing Outsourcing Medical Billing Compliance Fraud 59

Medisys Compliance

NOVEMBER 6, 2023

Compliance with Regulatory Guidelines Ensure that all claims are submitted per all applicable laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA), the Affordable Care Act (ACA), and the Medicare Fraud, Waste, and Abuse (FWA) laws. Stay up-to-date on all changes to regulatory requirements.

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Compliance Medical Billing Outsourcing Medical Billing ACA 59

Healthcare Law Blog

NOVEMBER 9, 2023

Thereafter, OIG said it planned to update existing industry-specific compliance program guidance (ICPG), which would include tailoring each to address fraud and abuse risk areas specific to a particular industry and describing the compliance measures that industry could take to reduce these risks [2].

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Compliance Compliance Officers Fraud Medicare 52

HIPAA Journal

MARCH 30, 2023

Synthetic accounts have been a problem in several sectors for many years but there is growing evidence that synthetic accounts are being used for healthcare fraud. These accounts are used to fraudulently obtain loans and make large purchases but are also being used for paying for medical billing and other health-related activity.

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Ransomware Fraud Governance Medical Billing 98

Healthicity

JUNE 7, 2022

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

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Fraud Medical Billing Compliance 98

HIPAA Journal

JANUARY 25, 2023

Logan Health Medical Center – was filed against Logan Health in the Montana Eighth Judicial District Court shortly after notification letters were mailed. Affected individuals were offered complimentary credit monitoring services. A lawsuit – Tafelski, et al.

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Medical Billing Fraud HIPAA Health Insurance 86

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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Fraud Compliance Officers Compliance Medicare 52

AIHC

JUNE 6, 2023

Due to the complex nature of accurate coding, charge capture, billing and reimbursement, AI technology holds the potential to transform medical billing. This is certainly an area where advanced technology is needed to reduce overhead, improve compliance and reduce billing errors.

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Compliance Medical Billing HIPAA Due Diligence 59

Healthcare IT Today

FEBRUARY 24, 2021

There has to be some quality monitoring to prevent fraud and upcoding, but a lot of the time, the doctor just hasn’t coded properly or filled out the […]. Doctors don’t seem flustered by bodily fluids or welts–what they dread is the hour-long calls with insurers, trying to persuade them to cover a test or procedure.

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Doctors Fraud Medical Billing 76

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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COVID-19 Compliance Fraud Doctors 52

AIHC

JUNE 6, 2023

Due to the complex nature of accurate coding, charge capture, billing and reimbursement, AI technology holds the potential to transform medical billing. This is certainly an area where advanced technology is needed to reduce overhead, improve compliance and reduce billing errors.

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Compliance Medical Billing HIPAA Due Diligence 52

Medisys Compliance

APRIL 27, 2022

Another goal was to prevent healthcare fraud. The post Tips to Keep Your Practice HIPAA Compliant appeared first on Leading Medical Billing Outsourcing Services Company in the USA. Healthcare providers, health plans, and healthcare clearinghouses are primarily covered under HIPAA.

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HIPAA Medical Billing Outsourcing Medical Billing Ransomware 52

Healthcare IT Today

AUGUST 3, 2023

EHR data is a prime target for cyber attackers, as it includes personal data and medical data that can be resold and used to perpetrate financial fraud, extortion, medical billing fraud, and illicit access to medication. Insecure medical devices can also be exploited to hurt patients and damage institutions.

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Healthcare IT Today

JANUARY 18, 2023

Analyzing conversational data helps identify human coding errors, reduce disruptive billing claim processes, prevent fraud and guide decision-making. It’s reported that somewhere around 80% of medical bills contain errors, which hurts the patient and the provider. Hadi Chaudhry, Chief Executive Officer at CareCloud.

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Medical Billing Fraud Hospitals 108

MedTrainer

JANUARY 26, 2024

Non-compliance in this area includes unauthorized access to patient records, inadequate data encryption, and improper disposal of medical records.

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Compliance Informed Consent HIPAA Medical Billing 52

AIHC

MARCH 2, 2023

The most challenging aspect of having my own medical billing and consulting company was working with people. I have also added the CFE, Certified Fraud Examiner through the Association of Certified Fraud Examiners. During these years I found myself primarily involved with providing structure and direction.

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Compliance Officers Compliance Fraud Medical Billing 52

MedTrainer

NOVEMBER 2, 2023

Their duties span across several areas, from ensuring adherence to laws to navigating the complexities of medical billing protocols. Compliance officers must understand these rules, ensuring organizations deliver quality care without fraud. What Is the Primary Role of a Compliance Officer in Healthcare?

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Compliance Officers Compliance HIPAA Regulatory Compliance 52

Medisys Compliance

APRIL 19, 2023

Providers must also comply with the AHCA Provider General Requirements and the Practitioner Services Handbook, which provide specific guidance on billing, documentation, and quality assurance requirements. Providers must also comply with Medicaid program integrity initiatives designed to prevent fraud, waste, and abuse.

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Medicaid Medicaid Medical Billing Outsourcing Licensing 52

Healthcare IT Today

JUNE 29, 2023

Expert Knowledge of Regulatory Changes ASC billing services providers understand current regulatory changes affecting ASC billing practices. They follow Medicare reimbursement policies, coding and documentation guidelines, HIPAA compliance, fraud, and abuse prevention, prior authorization, and state-specific regulations.

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Compliance Medicare Medicare Medical Billing 52

Med Law Blog

MAY 1, 2023

We saw that issue up close last year as the committee considered the role of PE firms in the increase of patients receiving surprise medical bills.” Private equity firms are investment firms set up to increase profits for their shareholders, not to provide better quality medicine.

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Nursing Homes Malpractice Hospitals Nurses 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.

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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.

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

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M York Hospital reaches vital tax deal, averting closure threat Rep.

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Nursing Homes Nurses Hospitals Doctors 40

HIT Consultant

MAY 22, 2023

What You Should Know: Mastercard and HealthLock have partnered to offer millions of Americans help in protecting themselves against medical bill fraud, claim errors and overcharges. HealthLock’s platform helps consumers audit every single medical insurance claim and keep them organized through a user-friendly dashboard.

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Fraud Medical Billing 52

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.

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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 .

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Medical Billing Medical Billing Outsourcing Doctors Fraud 98

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.

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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.

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Medical Billing Medical Billing Outsourcing Fraud Medical Billing Services 52