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HHS Finalizes Rule on Provider Information Blocking

Compliancy Group

On June 24, 2024, the Department of Health and Human Services (HHS) released a final rule establishing disincentives for healthcare providers who have engaged in information blocking. Information blocking is a practice by a provider that is likely to interfere with the access, exchange, or use of electronic health information (EHI).

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The Importance of Staying Informed

AIHC

There is value in learning from another organization’s lessons publicly posted by a government authority, such as the Department of Justice (DOJ), Centers for Medicare & Medicaid Services (CMS), the HIPAA enforcement agency, the Office of Civil Rights (OCR) or the Federal Bureau of Investigations (FBI).

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Understanding CPT Code 99204 – PCC Quick Guide

Physician Credentialing Company

It has 3 major categories, and all healthcare professionals should know about the CPT codes in each category. Category 1: This category holds the majority of CPT codes, and this is considered a large body of code. Evaluation and management codes are most reported in healthcare, and they also belong to this category.

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Why Payers Must Be Innovation Champions to Increase Healthcare Affordability

HIT Consultant

To rectify this, the Centers for Medicare & Medicaid Services (CMS) introduced the Inpatient Prospective Payment System. They used the data that was available to them to help inform innovation. One that examines all cost categories and leverages multiple data sources, including pricing transparency information.

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Conducting Internal Risk Adjustment Coding Audits

AIHC

Regulatory agencies and payers use hierarchical condition categories (HCCs) to calculate patient risk; the higher the risk score for a population, the higher the benchmark will be for expenditures, which can affect shared savings in value-based payment arrangements. Medicare & the OIG are performing Risk Adjustment audits, are you?

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Federal Jury Convicts New York Doctor of Healthcare Fraud Scheme

Med-Net Compliance

A federal jury convicted a New York ENT doctor for defrauding Medicare and Medicaid by causing the submission of false and fraudulent claims for surgical procedures that were not performed. Medicare and Medicaid data demonstrated that he was identified as an outlier and the highest biller for this procedure in New York State.

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OIG Posts False Claims Act Settlements for FY 2022 Q1–Q4 on the Risk Spectrum

Med-Net Compliance

The government’s primary civil tool for addressing healthcare fraud is the FCA. Most of these cases are resolved through settlement agreements in which the government alleges fraudulent conduct and the settling parties do not admit liability. Excluded individuals and entities are listed in the OIG’s exclusions database.

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