Corporate Compliance Articles by Topic: Auditing
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Medicare Insider, Issue 12, March 26, 2013
The Medicare Audit Improvement Act, which aims to rectify problems identified in the Recovery...
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Medicare Insider, Issue 12, March 26, 2013
Highlights of the past week’s Medicare updates include the accompanying transmittal for the...
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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...
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Medicare Insider, Issue 11, March 19, 2013
Performant Recovery posted four new issues across three categories, Connolly posted a new issue for...
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Medicare Insider, Issue 11, March 19, 2013
Effective Wednesday March 13, hospitals denied payment because a Part A inpatient stay was deemed...
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Medicare Insider, Issue 47, November 20, 2012
Editor’s note: Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc., is the...
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Medicare Insider, Issue 47, November 20, 2012
Other issuances: OIG issues reviews of Medicare appeals at the administrative law judge level in...
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Medicare Insider, Issue 46, November 13, 2012
Recovery Auditors on the hot seat: Scrutiny pouring in from numerous angles
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Medicare Insider, Issue 45, November 6, 2012
CMS issues Medicare system update to include rendering line level NPI for PCIP payments to CAHs
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Medicare Insider, Issue 34, August 21, 2012
The transcript & audio file from the August 9, 2012 Medicare Fee-For-Service Recovery Auditor...
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Medicare Insider, Issue 32, August 7, 2012
CMS will hold a special open door forum on the Medicare fee-for-service Recovery Auditor prepayment...
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Medicare Insider, Issue 26, June 26, 2012
CMS issues transmittal on provider self audits
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Compliance Monitor, Issue 22, June 1, 2011
Employees should only access information when they have a legitimate need to do so.
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Medicare Insider, Issue 2, January 11, 2011
On December 30, CMS issued two transmittals to implement updates to the OPPS for 2011. Changes...
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Compliance Monitor, Issue 42, November 10, 2010
Simi Valley (CA) Hospital paid the United States $5.1 million to resolve allegations that its...
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Compliance Monitor, Issue 41, November 3, 2010
If your facility has a robust compliance department, the recovery audit contractor (RAC) team may...
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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...
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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...
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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...
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Compliance Monitor, Issue 33, August 19, 2009
Q: What auditing and documentation is necessary to demonstrate HIPAA compliance?
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Compliance Monitor, Issue 32, August 12, 2009
For many providers, self-auditing has become an important RAC preparation tool. Certainly, internal...
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Compliance Monitor, Issue 31, August 5, 2009
Boston Clinical Laboratories reached a settlement with authorities and agreed to pay $615,000 to...
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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...
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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...
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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...
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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...
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Compliance Monitor, Issue 26, July 1, 2009
by Andrea Kraynak, CPC-A
CMS released further information June 24 on its RAC Web site letting...
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Compliance Monitor, Issue 21, May 27, 2009
On May 20, President Barack Obama signed the Fraud Enforcement and Recovery Act of 2009 (FERA...
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Health Care Auditing Strategies, Issue 5, May 1, 2009
This month in Healthcare Auditing Strategies, we’ll closely examine the differences between...
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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...
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Health Care Auditing Strategies, Issue 5, May 1, 2009
On January 15, CMS announced three national coverage determinations (NCD) that aim to protect...
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Health Care Auditing Strategies, Issue 5, May 1, 2009
Among the chaos of the emergency department (ED) lie several unique compliance challenges and...
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Compliance Monitor, Issue 17, April 29, 2009
Q: What is an invasive procedure?
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Compliance Monitor, Issue 14, April 8, 2009
To begin an evaluation and management (E/M) services audit, compare your facility with others in...
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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...
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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...
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Healthcare Auditing Weekly, Issue 11, March 24, 2009
A thorough understanding of evaluation and management (E/M) coding begins with documentation. If...
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Healthcare Auditing Weekly, Issue 10, March 17, 2009
A risk assessment allows a practice to take inventory of risk areas and identify current and...
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Healthcare Auditing Weekly, Issue 10, March 17, 2009
On March 12, the New York State Office of Medicaid Inspector General (OMIG) released Provider...
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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...
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Healthcare Auditing Weekly, Issue 9, March 10, 2009
Not all clinical trials/research studies are created equal. Clinical research studies can very by...
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Healthcare Auditing Weekly, Issue 8, March 3, 2009
The monitoring tool is perhaps the most important document in your compliance-monitoring toolkit...
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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...
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Health Care Auditing Strategies, Issue 3, March 1, 2009
Accurate coding and billing of drug and biological commodities is a detailed process.
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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...
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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...
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Healthcare Auditing Weekly, Issue 7, February 24, 2009
The OIG recommended the following controls to ensure that all allowable cardiac services are billed...
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Healthcare Auditing Weekly, Issue 6, February 17, 2009
On February 13, CMS released a transmittal asking contractors to strengthen safeguards that prevent...
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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...
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Compliance Monitor, Issue 6, February 11, 2009
Develop you risk-assessment process based on your organization’s size and needs. Consider...
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Healthcare Auditing Weekly, Issue 5, February 10, 2009
Develop your risk-assessment process based on your organization’s size and needs. To...
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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...
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Healthcare Auditing Weekly, Issue 5, February 3, 2009
When assessing risk, it’s crucial to have a solid understanding of your organization, the...
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Health Care Auditing Strategies, Issue 2, February 1, 2009
Upcoming changes to Stark Law should put financial arrangement audits at the top of compliance...
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Health Care Auditing Strategies, Issue 2, February 1, 2009
The OIG characteristically included many Medicare reviews, audits, and investigations in its 2009...
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Healthcare Auditing Weekly, Issue 4, January 27, 2009
It’s important to understand the details of the Emergency Medical Treatment and Active Labor...
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Healthcare Auditing Weekly, Issue 2, January 13, 2009
Follow these tips to audit the use of advance beneficiary notices (ABNs) in your facility and...
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Healthcare Auditing Weekly, Issue 2, January 13, 2009
Quality of care, Medicaid and the State Children’s Health Insurance Program (SCHIP), as well...
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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...
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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...
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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...
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Healthcare Auditing Weekly, Issue 45, December 2, 2008
The OIG believes an ongoing evaluation process is critical to a successful compliance program...
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Health Care Auditing Strategies, Issue 12, December 1, 2008
Beginning in March 2009, CMS will require Medicare Part B providers, including hospital outpatient...
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Health Care Auditing Strategies, Issue 12, December 1, 2008
by Camella Boateng
An estimated 44,000–98,000 American adults die each year from...
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Healthcare Auditing Weekly, Issue 44, November 25, 2008
Auditing alone is not enough to maintain an effective compliance program—organizations must...
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Healthcare Auditing Weekly, Issue 43, November 18, 2008
Every audit must begin with a clearly stated purpose that drives and defines the entire process...
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Healthcare Auditing Weekly, Issue 42, November 11, 2008
CMS announced Nov. 3 it has delayed the Medicare Recovery Audit Contractor (RAC) permanent program...
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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...
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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...
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Compliance Monitor, Issue 84, November 5, 2008
Tip: Cover all your bases in the ER
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Health Care Auditing Strategies, Issue 11, November 1, 2008
With the release of its fiscal year 2009 inpatient prospective payment system (IPPS) final rule...
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Health Care Auditing Strategies, Issue 11, November 1, 2008
Slowly but surely, providers are moving toward adoption of electronic health records (EHR) in hopes...
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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...
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Healthcare Auditing Weekly, Issue 41, October 28, 2008
Auditing alone is not enough to maintain an effective compliance program. Organizations must...
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Healthcare Auditing Weekly, Issue 40, October 21, 2008
Your involvement as a compliance officer and/or auditor can help improve your organization’s...
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Healthcare Auditing Weekly, Issue 39, October 14, 2008
The recovery audit contractor (RAC) program is not CMS’ only effort to fight fraud and abuse...
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Healthcare Auditing Weekly, Issue 39, October 14, 2008
CMS recently announced recovery audit contractor assignments for its permanent RAC program, making...
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Healthcare Auditing Weekly, Issue 39, October 14, 2008
In assessing risk, it’s crucial to have a solid understanding of your organizations, the...
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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...
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Healthcare Auditing Weekly, Issue 38, October 7, 2008
An effective auditor acts quickly to interpret new information and educate staff and providers when...
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Health Care Auditing Strategies, Issue 10, October 1, 2008
The Recovery Audit Contractor (RAC) demonstration project ended March 27, and providers are still...
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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...
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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...
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Healthcare Auditing Weekly, Issue 37, September 30, 2008
CMS released an updated evaluation of its recovery audit contractor (RAC) program, which shows...
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Healthcare Auditing Weekly, Issue 35, September 16, 2008
After the audit report is issued, the audit team should perform a post-audit evaluation. Its...
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Healthcare Auditing Weekly, Issue 35, September 16, 2008
Michigan’s Temporary Assistance for Needy Families (TANF) program made nearly $24 million in...
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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...
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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...
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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...
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Health Care Auditing Strategies, Issue 9, September 1, 2008
Physician documentation plays a big part of the billing process in medical facilities. But no...
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Health Care Auditing Strategies, Issue 9, September 1, 2008
Recovery audit contractors (RAC) arrive in 2010, so hospitals need to start preparing. Start by...
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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...
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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...
