Posted and filed under Compliance, Healthcare.

What to Watch Out For With Credit Balance

In May 2014, the Department of Health and Human Services, Office of Inspector General (OIG) published a proposed rule updating its regulations. The proposed rule will authorize civil monetary penalties for “failure to report and return a known overpayment,” among other issues.   The rule has outlined the penalty for failure to report and return overpayments…

Read the full article

Posted and filed under Community.

Advize Team Helps Raise Funds for Breast Cancer Patients

One of our Auditors, Mary Ireland, participated in the “Race for Hope” hosted by Canterbury Race Track in Shakopee, Minnesota on August 9th, 2015. The Canterbury Race Track, which is a horse racing track, hosts this event every year.  Derby hats were made for the event and donated by various groups/stores and individuals, to raise…

Read the full article

Posted and filed under Coding, ICD-10.

Are you Ready for the Shift to ICD-10?

On July 31st, 2014, the U.S. Department of Health and Human Services (HHS) issued a rule finalizing Oct.1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the international Classification of Disease. ICD-10 will provide an enhancement platform for physician…

Read the full article

Posted and filed under Healthcare.

What is the Underlying Cause of Tooth Decay?

Our diet! Tooth decay results from the acid produced when sugar and oral bacteria in the mouth combine and feed off each other. Frequently consuming foods higher in acid content can lead to irreversible dental erosion.  Dental erosion is the breakdown of the tooth’s structure; the outer layer called enamel.  Dental enamel is the thin…

Read the full article

Posted and filed under Coding, ICD-10.

Top 5 Reasons to Get Your ICD-10 Certification

5. If your employer does not currently require ICD-10 proficiency they likely will in the very near future. As we all know, ICD-10 is quickly approaching and it’s being implemented on October 1st. This is the system that everyone is going to be required to use, which is why it’s so crucial that all healthcare…

Read the full article

Posted and filed under YouBeTheCoder.

You Be The Coder: September

How many physical examination elements can you extract from this documentation? VS: 124/80, Pulse: 74, Weight: 174 pounds CTA A&Ox3 No CCE Answer below:   Answer: Six Constitutional – Vital Signs Respiratory – Clear to Auscultation (CTA) Psych – Alert and Oriented X 3 (A&Ox3). No CCE; (Clubbing, Cyanosis, Edema) Musculoskeletal (Clubbing) Cyanosis (Skin) Edema…

Read the full article

Posted and filed under Compliance.

Compliance Corner: September

What are the 3 core health activities where a covered entity could disclose a patient’s PHI? Answer: The core health care activities of “Treatment,” “Payment,” and “Health Care Operations” are defined in the Privacy Rule at 45 CFR 164.501.

Posted and filed under Medical Record Auditing.

The Benefits of DRG Validation

DRG validation is a tool that can be used to reduce risk, defend claims, and ensure the accuracy of the coded items. The purpose of DRG validation is to confirm that diagnostic, procedural information, and the discharge status of the beneficiary, as coded and reported by the hospital on its claim, matches both the attending…

Read the full article

Posted and filed under FWA.

Fraud Waste and Abuse Fact: August

DOJ and HHS Annual Report Highlights $3.3 Billion in Settlements and Judgments in FY 2014 “On March 19, 2015, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) issued their annual Health Care Fraud and Abuse Control (HCFAC) Program report highlighting that the HCFAC Program obtained $3.3 billion in health care…

Read the full article

Posted and filed under Coding, Compliance.

Medicare Guidance for Mid-Level Providers

Taking the Guesswork out of Correct Billing More and more health organizations are hiring midlevel providers to perform services that were formerly thought to be appropriate exclusively for medical physicians. While it is less costly to hire Physician Assistants, Nurse Practioners, and Certified Nurse Midwives, it’s imperative that institutions familiarize themselves with the rules regarding…

Read the full article