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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Posted and filed under Compliance, Healthcare.

Cybersecurity: Are You Helping the Hackers?

Last year, Houston-based software and security company Netiq released a Cyberthreat Defense Report that published alarming statistics on the apparent vulnerabilities in Healthcare IT. Data breaches, compromised patient information, medical identity theft, and gaping holes in Cloud infrastructure are among the top contenders for worst offenses. Now, a year later, the statistics are rising, and…

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Posted and filed under Compliance, FWA.

Clinical Labs Under Heavy Scrutiny After Cigna Lawsuit

A tidal wave of fraud has been approaching our shores for quite some time, and it’s finally broken land. The scheme, gaining popularity in clinical labs and pathology groups involves waiving patient fees and copays in order to send payer groups inflated claims fees. While these billing tactics might seem innocuous, they are fraudulent because…

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Posted and filed under Business, Compliance.

The Consequences of HIPAA Violations

 The below tiered civil penalty structure was established from the American Recovery and Reinvestment Act of 2009. The Secretary of HHS still has discretion in determining the penalty amount based on the nature and extent of the violation as well as the nature and extent of harm resulting from the violation.  The Secretary is prohibited…

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