Posted and filed under Compliance, Cybersecurity.

How Health Care Law Can Fix the EHR Problem

In what has been touted by industry experts as, “…the most important article no one [else] will read”, The Sedona Conference Journal has released an article diagnosing the many legal “illnesses” that plague Electronical Health Records (EHR), and the subsequent sharing of private information.  EHR was once regarded as the savior of health care information…

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Posted and filed under Compliance, Medical Record Auditing.

Sign, Seal, Deliver: Provider Signature Requirements

To a physician, providing authentication may appear as yet another inconvenience or hindrance to productivity in the midst of the already chaotic audit process – but it’s the difference between being reimbursed and having your claims denied. For the purpose of a medical record audit, Medicare requires that any services provided be authenticated within the…

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Posted and filed under Compliance, Medical Record Auditing.

Surviving the Medical Record Retrieval Process

Tackling a project as intricate as Medical Record Retrievals may seem daunting – and it is, but you can still make it through unscathed. Perhaps your firm was enlisted by an attorney, health plan, or medical auditing organization to retrieve medical records directly from a provider’s office. What tools do you need? How do you…

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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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