Stroll along the path to healthcare compliance. Effective compliance training can increase efficiency, allow providers to deliver higher quality care, ensure legal compliance, and maximize financial gain. Not sure where to start? Check out our easy, step-by-step process. Step 1: Know Your Entity Type Small physician offices have different compliance training requirements than large hospital ...
Dec 12th, 2017
The “Administrative Simplification: Certification of Compliance for Health Plans” proposed rule has been withdrawn. Although health plans still must comply with HIPAA electronic transaction regulations, they do not have to certify their compliance or else be fined. HHS Backs Down on Certification The U.S. Department of Health and Human Services (HHS) published the proposed rule Jan. 2, ...
Nov 15th, 2017
On Oct. 2, 2017, Change Request 9911 modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. As a result, certain payers secondary to Medicare were unable to process direct-billed claims because patient responsibility deductible and coinsurance amounts on the Medicare Remittance Advice (RA) showed...
Oct 4th, 2017
​The Department of Health and Human Services Office of Inspector General (OIG)  announced in June that it would update the work plan monthly, to enhance transparency. In the September 15 update to the Work Plan, the new items posted are several examinations of Medicaid programs, including a review of five states to determine the extent to which Medicaid ...
Minimizing risk is not just about having a compliance program, there are many other factors to account for. By Joette Derricks, MPA, FACMPE, CPC, CHC, CSSGB A compliance program that only incorporates the seven elements of an effective compliance program (as articulated in the U.S. Sentencing Commission Guidelines Manual) won’t win you bonus points when ...