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...

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...

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...

2016 Update: OIG/OCR Audit Process

OCR’s Privacy, Security, and Breach Notification Audit Program: Although the ever-expanding use of health information technology in health care provides many benefits, in turn it poses new risks to consumer privacy. To ensure HIPAA compliance, HITECH requires HHS to...