by Advize Admin | Jul 1, 2022 | Compliance, Events, Healthcare, Technology
Recently we presented to New York State Adult Day Services Association (NYSADSA) on this very topic. For those of you who do not know, NYSADSA is comprised of individuals, single-site programs, multiple-site programs, professional organizations, and supporters...
by Advize Admin | Mar 25, 2022 | Compliance
Providers are most often paid in Fee-For-Service (FFS) models for visits AFTER they occur. The patient sees a provider, a service or procedure is performed, and a bill (claim) goes to the health insurance plan (payor/issuer) for reimbursement for those services that...
by Advize Admin | Mar 11, 2022 | Compliance
Risk adjustment is a newer payment methodology that is designed to allow for a proactive approach to managing healthcare. It does not seek to audit against current claims or encounters. It is a yearly collection of diagnosis codes to accurately build a total RAF (Risk...
by Brian Boyce | Mar 4, 2022 | Compliance
Background Anyone who has taken the CRC™ (Certified Risk Adjustment Coder) curriculum can tell you that risk adjustment was first utilized in the mid-90’s for Medicaid purposes. The goal of risk adjustment has always been to collect data on patients so that money...
by Advize Admin | Feb 4, 2022 | Compliance
Providers who are lucky enough to have their fraud, waste, and abuse matters resolved through a civil settlement (either via the US Attorney’s Office or the Office of Counsel to the Inspector General-a CMPL action), can sometimes have a clause in the settlement that...
by Advize Admin | Sep 10, 2021 | Compliance
The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care? Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one...
by Advize Admin | Aug 13, 2021 | Compliance, FWA
The clock was about to strike midnight, and Scott Newman was desperately feeding pages into a scanner, trying to prevent thousands of dollars in prescription payments from turning into a pumpkin. As the owner of Newman Family Pharmacy, an independent drugstore in...
by Advize Admin | Jul 9, 2021 | Compliance
Many of us have visited a doctor’s office. And in many circumstances our doctors visit includes a follow up correspondence of some sort. Whether it was a medical assistant contacting a patient to set up his/her next doctor’s visit, or in some cases a follow up...
by Advize Admin | May 20, 2021 | Compliance, Medical Record Auditing
As new technologies progress more and more payers are actively deploying AI capable systems. This shift is now producing more audits of physicians than ever before and directly contributing to higher rates of denials. Audits take time and...
by Advize Admin | Feb 26, 2021 | Compliance
by guest contributor, Mark R. Brengelman, JD, MA Previous: The Role of State Boards of Dentistry (Part 1) This article provides another part into the perspective on the role of state boards of dentistry implementing the regulation of the practice of dentistry as a...
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