In CMS
Jan 21st, 2019
Intermountain Healthcare wants the Supreme Court to weigh in on if the False Claims Act’s (FCA) provisions for whistleblowers violates the Constitution. This could affect compliance efforts across healthcare. Medical Judgment No FCA Sanctuary The issue arose last summer when the US Court of Appeals for the Tenth Circuit ruled that medical judgment can’t be ...
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 ...
In CMS
May 26th, 2017
Medicare Access and CHIP Reauthorization Act of 2015 will shake how providers are reimbursed to the core, as they are paid based on the quality of care versus the quantity of care through a fee-for-service model. How are providers and others in the industry going to cope with this new law, which was passed with bi-partisan ...
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 ...
Jun 1st, 2012
Here’s what to do when your provider’s documentation takes a back seat. By Robyn Margani, CPC If it isn’t documented, it wasn’t done. That’s the golden rule of coding. As we’ve all been told again and again, inaccurate documentation can lead to improper payments, non-compliance with government and insurance regulations, and audit risks. Unfortunately, the ...