Posted and filed under Coding, Compliance, FWA, Healthcare.

Pre-Litigation Considerations

Law firms have been known to enlist the help of a third-party when dealing with healthcare fraud cases. This is because in addition to investigating the allegations against one party, there is a myriad of additional pre-litigation considerations. In multi-faceted cases in which health plan overpayments are being pursued within the judicial system an audit…

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Posted and filed under Compliance, Cybersecurity, Healthcare.

HITRUST FAQ

Q: Just what is HITRUST anyway? A: HITRUST is a common security framework (CSF) created and governed by the HITRUST Alliance, a privately held U.S. company made up of leaders from healthcare, technology, and information security. The framework is comprised of several prescriptive security controls that can be assessed to determine the level of information…

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Posted and filed under Coding, Compliance, Cybersecurity, Fraud.

Safeguard Your EHR

If healthcare was a chemical solution, and relevant technologies were solutes – the mixture would quickly become a fragmented clump of, well…various technologies. The healthcare market is over-saturated with technology designed to “fix” the present problems plaguing the ecosystem. Of course, in a paradoxical twist of fate, these solutions come with a new set of…

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Posted and filed under Compliance, Healthcare.

Pennsylvania Examines Breadth of Peer Review Protection Act

On December 13, 2012, a newborn was delivered via C-section by a physician at the Scranton Quincy Hospital Company LLC. Despite the surgical means of delivery, the child suffered an acute hypoxic ischemic brain injury (P91.60) that ultimately resulted in permanent disability. The parents of the child decided to take legal action against the obstetrician…

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Posted and filed under Coding, Compliance, Fraud.

Upcoding vs. Downcoding

Physicians and their billing/coding staff have an established history with, and an acute awareness of upcoding and overpayments. In fact, unless they’re operating within a fraudulent billing scheme, they’re avoiding the practice of upcoding all together. Upcoding is arguably the most common red flag in both audit selections and audit results, making it a serious…

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Posted and filed under Compliance, Healthcare.

OCR Cracking Down on HIPAA Violations

The Health Insurance Portability and Accountability Act (HIPAA) has a primary goal of protecting the confidentiality and security of healthcare in formation, and has established standards for electronic data interchange (EDI). HIPAA is celebrating its twenty-first anniversary this year, after its enactment on August 21, 1996. HIPAA was groundbreaking at the time, with standards in…

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Posted and filed under Coding, Compliance, Healthcare.

Listen Up, Doc. These MACRAnyms Can Make You Money in 2017.

If you’re in the healthcare industry – you’ve heard about MACRA. The Medicare Access and CHIP Authorization Act, Medicare’s two-track payment system for physicians and healthcare providers will be implemented on January 1st, 2017. Understanding the new system and rules that comes along with MACRA’s implementation is vital for the success of physicians and hospitals….

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Posted and filed under Coding, Compliance.

Understanding the Vaccines for Children Program

Please refer to our accompanying article Vaccine Administration Counseling for more information on vaccine coding and documentation. The Vaccines for Children (VFC) Program is a federally funded program that offers vaccines at no cost for eligible children through doctors enrolled in the program. The CDC provides information for Healthcare providers to become a VFC provider….

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Posted and filed under Compliance, Cybersecurity.

How Incident Response Plans Can Save Your Bottom Line

In June Advize Health’s very own Joshua McElroy participated in a panel hosted at WellCare in Tampa, FL. Joshua was in the company of three other subject matter experts from Schellman & Company, Bright House Networks, and Kroll who all spoke on the topic of “Incident Response Plan: From a Reactive to Proactive Approach”. The…

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Posted and filed under Compliance, Fraud, Healthcare.

Healthcare’s Data Vulnerability Problem

A study conducted by three universities has revealed a fatal flaw in the healthcare industry’s cyber security operations – lack of cohesion between cyber security protocol and the proper execution of such procedures. Healthcare organizations are vulnerable to data breaches because cyber security efforts are perceived as an interruption of clinical workflow, rather than as…

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