In Audit
May 17th, 2018
There has been a lot of focus recently on large fraud schemes uncovered by the government and many are wondering how this affects “me.” By Evelyn Kim, MBA, CFE, CPC, CPMA, CRC, AAPC Fellow Healthcare fraud is a thriving enterprise in the United States. The latest statistics from the Centers for Medicare & Medicaid Services ...
Favorable outcomes require a plan for gathering information, conducting interviews, and bringing in legal counsel. By Erica Lindsay, PharmD, MBA, Esq. To maintain effective compliance, healthcare entities may have to conduct internal investigations. To ensure efficiency in the process and consistency in the results, you’ll need a solid and enforceable company policy for compliance. Let’s ...
Chart a course for a healthy revenue cycle in tumultuous times. Medical auditing is critical to a compliant and profitable physician practice. This, along with the increased specificity of ICD-10 and the end of the one-year grace period for using non-specific codes without denials, means that well-structured coding compliance and auditing programs are on the ...
In Audit
Jan 31st, 2018
Instead of posting a yearly work plan for their invesigational efforts, The Office of Inspector General (OIG) now posts Active Work Plan items monthly. It’s because the U.S. Department of Health and Human Services (HHS) announced in June 2017 that it is updating the OIG Work Plan more frequently as an ongoing effort to enhance ...
Communication is essential to a smooth appeals process. Your practice was the subject of a special investigation unit (SIU) audit, and now the payer is asking for a refund. You have two choices: pay or appeal. If you disagree with the findings, the smart choice is to meet with the payer, appeal the findings, and ...