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 ...
Understand your providers to better meet their documentation and coding education needs. One of the biggest challenges an auditor can face is educating providers on what went wrong with their coding and documentation. Provider reactions can run the gamut, from enthusiastically investing in learning to apathy or defensiveness. Effective education begins with learning: first – ...
In Audit
Nov 22nd, 2017
The Office of Inspector General (OIG) is recommending Rush University Medical Center, Chicago, Ill., refund $10.2 million in Medicare overpayments based on an audit sample of 120 inpatient and outpatient claims. Rush allegedly did not fully comply with Medicare billing requirements for 57 of the claims, resulting in overpayments of $814,150 for the audit period (2014-2015). The OIG ...
New prepayment audits underscore the importance of proper EHR use. If your practice, clinic, or hospital uses an electronic health record (EHR) but does not have a current “copy and paste” policy, it’s time to create one. To understand why this is important, let’s consider long-standing evaluation and management (E/M) coding challenges, how payers are ...
Four best practices when following radiology compliance regulations. By Kim Wells, CPC, CPMA, CEMC, AAPC Fellow The issue of healthcare fraud and abuse has attracted a lot of attention in recent years, primarily because the financial losses attributed to it are estimated to be billions of dollars, annually. Below are four tips for ensuring your ...