Posted and filed under Coding, FWA.

Investigating Health Plan Overpayments

Picture yourself balancing on top of a fence with vast expanses of land, each with their own set of governance, visible to you from both sides. You’re straddling the fence, your legs occupying each of the divided spaces. Where do you stand? It depends on which way the wind blows. Such is the case with…

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Third Annual Orlando Health Care Forum

Join our Managing Director, Jeanmarie Loria, as she participates on the panel, “Compliance from the Top: Board Responsibility for Compliance Oversight” at the Third Annual Orlanda Health Care Forum.

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 Compliance.

Compliance Corner – October

If a patient is deceased, may a covered entity disclose to a family member who was involved in the patient’s care or payment for healthcare prior to the death, PHI of the deceased? Answer: Yes, unless there is an expressed statement to the contrary. (45CR 164.510)

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…

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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 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…

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Posted and filed under Coding, Compliance, Medical Record Auditing.

Vaccine Administration Counseling

Vaccine administration coding and documentation is often confused by many providers, billers, coders, and even auditors.  One misunderstanding is what exactly is a toxoid component? And what documentation is necessary to support billing vaccine administration with counseling?  Here’s a quick look at the codes we are talking about. A toxoid component according to CPT refers…

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Posted and filed under Compliance.

Compliance Corner: August

Define the principle of “minimum necessary”? Answer: a covered entity must make reasonable efforts to use, disclose and request only the minimum amount of PHI needed to accomplish the intended purpose of it’s use

Posted and filed under Careers, Coding, Medical Record Auditing.

Why you Should Consider a Career as an Auditor

As Advize Health continues to hire part-time and full-time remote Auditors, we felt it necessary to inform you of the reasons why you should consider a career in auditing and its benefits. Some of the perks you can enjoy as an auditor at Advize Health include: Free education with CEU’s provided through monthly auditor calls…

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