In CMS
Feb 28th, 2017
New compliance program guidance has been issued by the Fraud Section of the Department of Justice (DOJ), according to an article published in the AHLA Weekly. Although the “Evaluation of Corporate Compliance Programs” (Guidance) is not specific to the healthcare industry, it does provide a practical set of benchmarks against which the audit & compliance committee, in ...
In Billing
Feb 3rd, 2017
Effective Feb. 21, 2017, hospitals and critical access hospitals (CAHs) must provide the Medicare Outpatient Observation Notice (MOON), or CMS-10611, to patients with Original Medicare who are receiving outpatient observation services for more than 24 hours. The MOON must be delivered to applicable patients no later than 36 hours after outpatient observation services begin, but ...
In Audit
Jan 10th, 2017
If you haven’t stumbled on the treasure trove of information in the Office of Inspector General’s (OIG) Media section of their website, it’s time you found it. OIG now keeps you informed on fraud, enforcement, and compliance via podcast. The podcasts are found on the OIG website with Mike Kane, Office of External Affairs, discussing the monthly ...
Promote a compliant environment within your organization, before the whistle is blown. The most notable Medicare fraud cases in the last five years have been whistleblower cases in which someone with inside knowledge of a health system or physician practice (usually an employed physician or administrator) files suit against the employer under the federal False ...
Part 2: Takeaways to help you avoid over-documentation and comply with LCDs and NCDs. Compliance officers face several major issues in today’s healthcare arena. Besides HIPAA, Stark Law, and Anti-Kickback concerns, certain billing compliance issues continue to appear in federal government false claims settlement agreements and audit reports. We discussed two of those issues last ...