Posted and filed under Dental, Fraud, FWA.

Fraud Round-Up

If you read the news, you know that health care fraud is just as prevalent as ever. During any given time, you will be able to find a headline about a provider or care giver defrauding patients, insurance companies, or CMS in every state across the nation. This month we’ve seen quite a few colorful…

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Posted and filed under Medical Record Auditing, Payers.

The Claims Denial Epidemic

The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the program’s impact in the second quarter of the year 2016. The results suggest that while Medicare…

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

How Much Are Your Policies Costing You?

A medical record audit can reveal over-payments for up-coding, incorrect numbers of units billed, and the abuse of modifiers – just to list a few. Given the popularity of such indiscretions, what is being done after the money is recovered? Do you intend on data mining again in six months, hoping that the provider will…

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Posted and filed under FWA.

Top Recent Regulatory Activities by the US Government

Recently, the U.S. Government has been undertaking regulatory activities to drive down healthcare costs and improve patient outcomes. It is crucial to keep an eye on published regulations. One of the Centers for Medicare and Medicaid Services’ (CMS) key goals is to pay claims right the first time. This means paying the right amount to…

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Posted and filed under Healthcare.

The Two Midnight Rule 2016 Exception

CMS released CY 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule (CMS 1633 P). In which they propose to allow an exception to the controversial Two Midnight Rule. This proposed change is in recognition that there may be times when an inpatient admission (Part A payment) may be clinically warranted for stays that span less…

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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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