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 ...
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 ...
In Audit
Aug 15th, 2017
Effective June 15, 2017, the Office of Inspector General (OIG) now updates its Work Plan website, monthly. The OIG Work Plan sets forth various projects — including OIG audits and evaluations that are underway or planned — to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of ...