Corporate Compliance

Corporate Compliance Articles by Topic: Auditing

Medicare Audit Improvement Act reintroduced, AHIMA shows support

  • Medicare Insider, Issue 12, March 26, 2013

    The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...

The week in Medicare updates

  • Medicare Insider, Issue 12, March 26, 2013

    Highlights of the past week’s Medicare updates include the accompanying transmittal for the...

Note from the instructor: Details released on Part A to B rebilling ruling

  • Medicare Insider, Issue 12, March 26, 2013

    Most of you reading this likely already know that CMS released a ruling on March 13 that revises...

Recent Recovery Auditor Activity

  • Medicare Insider, Issue 11, March 19, 2013

    Performant Recovery posted four new issues across three categories, Connolly posted a new issue for...

CMS issues proposed changes to Part B inpatient billing in hospitals

  • Medicare Insider, Issue 11, March 19, 2013

    Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...

Note from the instructor: OIG weighs in on ALJ appeals

  • Medicare Insider, Issue 47, November 20, 2012

    Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...

Other issuances: OIG issues reviews of Medicare appeals at the Administrative Law Judge level in 2010 and payments to skilled nursing facilities in 2009

  • Medicare Insider, Issue 47, November 20, 2012

    Other issuances: OIG issues reviews of Medicare appeals at the administrative law judge level in...

Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

  • Medicare Insider, Issue 46, November 13, 2012

    Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles

Transmittals and MLN Matters articles: CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs and much more

  • Medicare Insider, Issue 45, November 6, 2012

    CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs

CMS Public Events: Recovery Auditor prepayment review ODF transcript and audio

  • Medicare Insider, Issue 34, August 21, 2012

    The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...

CMS Public Events: Special Recovery Auditor prepayment review demonstration open door forum

  • Medicare Insider, Issue 32, August 7, 2012

    CMS will hold a special open door forum on the Medicare fee-for-service Recovery Auditor prepayment...

Transmittals and MLN Matters articles: CMS instructs on provider self audits

  • Medicare Insider, Issue 26, June 26, 2012

    CMS issues transmittal on provider self audits

Tip: Regulate access to electronic medical records.

  • Compliance Monitor, Issue 22, June 1, 2011

    Employees should only access information when they have a legitimate need to do so.

Transmittals and MLN Matters articles: CMS updates OPPS, issues MLN Matters articles, and more

  • Medicare Insider, Issue 2, January 11, 2011

    On December 30, CMS issued two transmittals to implement updates to the OPPS for 2011. Changes...

CA hospital settles Medicare fraud case for $5.1M

  • Compliance Monitor, Issue 42, November 10, 2010

    Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its...

Tip: Consider the compliance department's role in your facility's RAC team

  • Compliance Monitor, Issue 41, November 3, 2010

    If your facility has a robust compliance department, the recovery audit contractor (RAC) team may...

Stop readmissions when you can

  • Strategies for Health Care Compliance, Issue 9, September 1, 2009

    CMS data show that hospitals will readmit one in five patients who leave the facility today within...

Auditors: Watch out for coding compliance issues

  • Strategies for Health Care Compliance, Issue 9, September 1, 2009

    Auditors can ensure that coders are following regulations and policies by watching out for the...

Strategies for Health Care Compliance, September 2009

  • Strategies for Health Care Compliance, Issue 9, September 1, 2009

    In this issue of Strategies for Health Care Compliance, we’ll take a look at unnecessary...

Q&A: Documenting HIPAA compliance

  • Compliance Monitor, Issue 33, August 19, 2009

    Q: What auditing and documentation is necessary to demonstrate HIPAA compliance?

Surprise! Voluntary refunds don’t protect against RACs

  • Compliance Monitor, Issue 32, August 12, 2009

    For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...

Boston laboratory agrees to pay $629,000 in fraud settlement

  • Compliance Monitor, Issue 31, August 5, 2009

    Boston Clinical Laboratories reached a settlement with authorities and agreed to pay $615,000 to...

Nine lessons from the RAC demonstration program

  • Strategies for Health Care Compliance, Issue 8, August 1, 2009

    Tracking appeals is the single most important way to survive a RAC audit because it allows you to...

E/M auditing: Avoid denials and lost revenue with audits

  • Strategies for Health Care Compliance, Issue 8, August 1, 2009

    Whether a practice is small or large, E/M coding is an integral part of the revenue cycle. In 2002...

HCCA Compliance Institute roundup: OIG illustrates five principles of compliance

  • Strategies for Health Care Compliance, Issue 7, July 1, 2009

    With an entire generation of baby boomers getting ready to sign up for Medicare, the OIG is gearing...

Strategies for Health Care Compliance, July 2009

  • Strategies for Health Care Compliance, Issue 7, July 1, 2009

    This month in Strategies for Health Care Compliance, we’ll take a look at some of the issues...

Complex reviews to arrive as soon as August

  • Compliance Monitor, Issue 26, July 1, 2009

    by Andrea Kraynak, CPC-A CMS released further information June 24 on its RAC Web site letting...

Obama signs fraud bill into law

  • Compliance Monitor, Issue 21, May 27, 2009

    On May 20, President Barack Obama signed the Fraud Enforcement and Recovery Act of 2009 (FERA...

Healthcare Auditing Strategies May 2009

  • Health Care Auditing Strategies, Issue 5, May 1, 2009

    This month in Healthcare Auditing Strategies, we’ll closely examine the differences between...

Medical necessity important element of audits<

  • Health Care Auditing Strategies, Issue 5, May 1, 2009

    Every audit has unique components to check depending on whether you audit a certain department, a...

Understand how never events, HACs differ

  • Health Care Auditing Strategies, Issue 5, May 1, 2009

    On January 15, CMS announced three national coverage determinations (NCD) that aim to protect...

ED auditing includes many components

  • Health Care Auditing Strategies, Issue 5, May 1, 2009

    Among the chaos of the emergency department (ED) lie several unique compliance challenges and...

Q&A: What is an invasive procedure?

  • Compliance Monitor, Issue 17, April 29, 2009

    Q: What is an invasive procedure?

Tip: Compare your facility to others when performing an E/M audit

  • Compliance Monitor, Issue 14, April 8, 2009

    To begin an evaluation and management (E/M) services audit, compare your facility with others in...

Tip: What to do if there is a noncompliance problem

  • Healthcare Auditing Weekly, Issue 13, April 7, 2009

    Deciding what to do when there’s an instance of wrongdoing may be the hardest part of an...

Healthcare Auditing Strategies April 2009

  • Health Care Auditing Strategies, Issue 4, April 1, 2009

    This month in Healthcare Auditing Strategies, we go in depth on E/M services audits, outlining...

Tip: Perform documentation audit when reviewing E/M coding

  • Healthcare Auditing Weekly, Issue 11, March 24, 2009

    A thorough understanding of evaluation and management (E/M) coding begins with documentation. If...

Tip: Follow these five steps for an effective risk assessment

  • Healthcare Auditing Weekly, Issue 10, March 17, 2009

    A risk assessment allows a practice to take inventory of risk areas and identify current and...

State Medicaid Agency publishes self-disclosure guidance

  • Healthcare Auditing Weekly, Issue 10, March 17, 2009

    On March 12, the New York State Office of Medicaid Inspector General (OMIG) released Provider...

CMS continued Advantage payments after beneficiaries' deaths

  • Healthcare Auditing Weekly, Issue 10, March 17, 2009

    On March 4, the OIG reported CMS made $4.4 million in unallowable payments to Medicare Advantage...

Tip: Audit clinical research billing to identify and reduce risk areas

  • Healthcare Auditing Weekly, Issue 9, March 10, 2009

    Not all clinical trials/research studies are created equal. Clinical research studies can very by...

Tip: Use monitoring tool to facilitate by-department reviews

  • Healthcare Auditing Weekly, Issue 8, March 3, 2009

    The monitoring tool is perhaps the most important document in your compliance-monitoring toolkit...

OIG finds overpayments in Indiana Medicaid agency

  • Healthcare Auditing Weekly, Issue 8, March 3, 2009

    The Office of Medicaid Policy and Planning in Indiana made more than half a million dollars in...

Clear up the confusion in drug/biologicals audits

  • Health Care Auditing Strategies, Issue 3, March 1, 2009

    Accurate coding and billing of drug and biological commodities is a detailed process.

EHR compliance: Audit copy/paste function use

  • Health Care Auditing Strategies, Issue 3, March 1, 2009

    Almost anyone who uses a computer is aware of its copy and paste capabilities. You can use it to...

Healthcare Auditing Strategies, March 2009

  • Health Care Auditing Strategies, Issue 3, March 1, 2009

    This month in Healthcare Auditing Strategies, we take a close look at the ailing economy?s effects...

Tip: Make sure cardiac rehab billing lines up with Medicare requirements

  • Healthcare Auditing Weekly, Issue 7, February 24, 2009

    The OIG recommended the following controls to ensure that all allowable cardiac services are billed...

CMS calls for proper use of modifier - 79

  • Healthcare Auditing Weekly, Issue 6, February 17, 2009

    On February 13, CMS released a transmittal asking contractors to strengthen safeguards that prevent...

Tip: Seven steps to establish by-department monitoring

  • Healthcare Auditing Weekly, Issue 6, February 17, 2009

    While there is no right or wrong way to set up a compliance-monitoring program, we have created a...

Tip: How to attack risks

  • Compliance Monitor, Issue 6, February 11, 2009

    Develop you risk-assessment process based on your organization’s size and needs. Consider...

Tip: Follow these ten steps to identify vulnerabilities before a risk-based audit

  • Healthcare Auditing Weekly, Issue 5, February 10, 2009

    Develop your risk-assessment process based on your organization’s size and needs. To...

Featured Audit Plan: Medical Necessity Monitoring

  • Healthcare Auditing Weekly, Issue 5, February 3, 2009

    Looking for a particular audit plan that may help make your job easier? Turn to the "Audit...

Tip: Assess risk, know organization through interviews

  • Healthcare Auditing Weekly, Issue 5, February 3, 2009

    When assessing risk, it’s crucial to have a solid understanding of your organization, the...

Make Stark compliance a priority this year

  • Health Care Auditing Strategies, Issue 2, February 1, 2009

    Upcoming changes to Stark Law should put financial arrangement audits at the top of compliance...

Don’t forget about Medicaid: 2009 OIG Work Plan highlights compliance concerns

  • Health Care Auditing Strategies, Issue 2, February 1, 2009

    The OIG characteristically included many Medicare reviews, audits, and investigations in its 2009...

Tip: Follow EMTALA compliance steps to avoid violations

  • Healthcare Auditing Weekly, Issue 4, January 27, 2009

    It’s important to understand the details of the Emergency Medical Treatment and Active Labor...

Tip: Ensure ABN compliance with regular auditing

  • Healthcare Auditing Weekly, Issue 2, January 13, 2009

    Follow these tips to audit the use of advance beneficiary notices (ABNs) in your facility and...

OIG highlights biggest compliance challenges for 2009

  • Healthcare Auditing Weekly, Issue 2, January 13, 2009

    Quality of care, Medicaid and the State Children’s Health Insurance Program (SCHIP), as well...

Featured Audit Plan: HIPAA privacy and security compliance assurance plan

  • Healthcare Auditing Weekly, Issue 2, January 13, 2009

    Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

Featured Audit Plan: Observation Services

  • Healthcare Auditing Weekly, Issue 45, December 2, 2008

    Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

OIG review finds CMS behind on audit recommendations

  • Healthcare Auditing Weekly, Issue 45, December 2, 2008

    During a recent review, the OIG found that during fiscal years 2006 and 2007, CMS resolved 3,462 of...

Tip: Audit compliance program to determine effectiveness

  • Healthcare Auditing Weekly, Issue 45, December 2, 2008

    The OIG believes an ongoing evaluation process is critical to a successful compliance program...

New CMS rules for ABNs require auditing

  • Health Care Auditing Strategies, Issue 12, December 1, 2008

    Beginning in March 2009, CMS will require Medicare Part B providers, including hospital outpatient...

Scrutiny of medical errors increases

  • Health Care Auditing Strategies, Issue 12, December 1, 2008

    by Camella Boateng An estimated 44,000–98,000 American adults die each year from...

Tip: Monitor potential risk areas

  • Healthcare Auditing Weekly, Issue 44, November 25, 2008

    Auditing alone is not enough to maintain an effective compliance program—organizations must...

Tip: Create a mission statement for your audit

  • Healthcare Auditing Weekly, Issue 43, November 18, 2008

    Every audit must begin with a clearly stated purpose that drives and defines the entire process...

RAC permanent program on standby

  • Healthcare Auditing Weekly, Issue 42, November 11, 2008

    CMS announced Nov. 3 it has delayed the Medicare Recovery Audit Contractor (RAC) permanent program...

Featured Audit Plan: Advance Beneficiary Notice practices

  • Healthcare Auditing Weekly, Issue 1, November 11, 2008

    Looking for a particular audit plan that may help make your job easier? Turn to the “Audit...

Other Issuances: OIG releases reports on DSH payments, oxaliplatin billing

  • Medicare Insider, Issue 45, November 11, 2008

    On November 7, the OIG issued a report on DSH capital payments for the period October 1, 2000...

Tip: Cover all your bases in the ER

  • Compliance Monitor, Issue 84, November 5, 2008

    Tip: Cover all your bases in the ER

Three HACs added in IPPS rule

  • Health Care Auditing Strategies, Issue 11, November 1, 2008

    With the release of its fiscal year 2009 inpatient prospective payment system (IPPS) final rule...

Proceed to EHR with caution, planning

  • Health Care Auditing Strategies, Issue 11, November 1, 2008

    Slowly but surely, providers are moving toward adoption of electronic health records (EHR) in hopes...

RAC guinea pigs give glimpse of what’s to come

  • Health Care Auditing Strategies, Issue 11, November 1, 2008

    As recovery audit contractors (RAC) start to spread across the country in a permanent CMS auditing...

Tip: Follow the OIG's suggestions for monitoring compliance program

  • Healthcare Auditing Weekly, Issue 41, October 28, 2008

    Auditing alone is not enough to maintain an effective compliance program. Organizations must...

Tip: Stay involved and informed in your role at your organization?s compliance program

  • Healthcare Auditing Weekly, Issue 40, October 21, 2008

    Your involvement as a compliance officer and/or auditor can help improve your organization’s...

CMS increases fraud prevention

  • Healthcare Auditing Weekly, Issue 39, October 14, 2008

    The recovery audit contractor (RAC) program is not CMS’ only effort to fight fraud and abuse...

CMS announces RACs, program improvements

  • Healthcare Auditing Weekly, Issue 39, October 14, 2008

    CMS recently announced recovery audit contractor assignments for its permanent RAC program, making...

Tip: Use interviews to understand your organization and assess risk

  • Healthcare Auditing Weekly, Issue 39, October 14, 2008

    In assessing risk, it’s crucial to have a solid understanding of your organizations, the...

Work plan lists nine new audits and reviews for hospitals

  • Healthcare Auditing Weekly, Issue 38, October 7, 2008

    The OIG released its 2009 work plan October 1, listing audits and reviews with an emphasis on...

Ask these questions about your compliance program

  • Healthcare Auditing Weekly, Issue 38, October 7, 2008

    An effective auditor acts quickly to interpret new information and educate staff and providers when...

Take a long-term approach to short-stay audits

  • Health Care Auditing Strategies, Issue 10, October 1, 2008

    The Recovery Audit Contractor (RAC) demonstration project ended March 27, and providers are still...

Encoder software may lead to clinically inaccurate coding

  • Health Care Auditing Strategies, Issue 10, October 1, 2008

    Encoder software used in hospital coding departments can lull coders into a false sense of security...

Hectic ERs present audit challenges, compliance risks

  • Health Care Auditing Strategies, Issue 10, October 1, 2008

    A fast-paced and often demanding environment makes the emergency room (ER) a unique challenge for...

CMS provides updated RAC numbers

  • Healthcare Auditing Weekly, Issue 37, September 30, 2008

    CMS released an updated evaluation of its recovery audit contractor (RAC) program, which shows...

Tip: Perform a post-audit evaluation to assess strengths and weaknesses

  • Healthcare Auditing Weekly, Issue 35, September 16, 2008

    After the audit report is issued, the audit team should perform a post-audit evaluation. Its...

Michigan overpays more than 200,000 families in assistance program

  • Healthcare Auditing Weekly, Issue 35, September 16, 2008

    Michigan’s Temporary Assistance for Needy Families (TANF) program made nearly $24 million in...

Featured Audit Plan: Compliance Effectiveness

  • Healthcare Auditing Weekly, Issue 33, September 2, 2008

    Looking for a particular audit plan that may help make your job easier? Turn to the "Audit...

Tip: How to handle instances of noncompliance

  • Healthcare Auditing Weekly, Issue 33, September 2, 2008

    Deciding what to do when there’s an instance of wrongdoing may be the hardest part of an...

Timing is important when auditing observation status

  • Health Care Auditing Strategies, Issue 9, September 1, 2008

    Some compliance mistakes never seem to go away, no matter how hard you try. "I would say it's a...

Five tips to audit coders for compliant claims

  • Health Care Auditing Strategies, Issue 9, September 1, 2008

    Physician documentation plays a big part of the billing process in medical facilities. But no...

Be prepared for RACs with internal audits

  • Health Care Auditing Strategies, Issue 9, September 1, 2008

    Recovery audit contractors (RAC) arrive in 2010, so hospitals need to start preparing. Start by...

Medicaid integrity contractor audits soon to follow RACs

  • Health Care Auditing Strategies, Issue 9, September 1, 2008

    Worried about recovery audit contractors (RAC)? They are only part of the incoming dust storm of...

Clinical documentation programs result in fewer errors, improved compliance

  • Health Care Auditing Strategies, Issue 9, September 1, 2008

    How can coders ensure that they assign the correct present-on-admission (POA) indicator? How can...