HCPro.com: Strategies for Health Care Compliance

News and real-life examples to increase the effectiveness of your compliance program. Strategies for Health Care Compliance will be your guide for avoiding fraud and maintaining compliance.

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December 2008 (Volume 12, Issue 12)	view entire issue

Examine short stays, avoid overpayment
When the recovery audit contractor (RAC) demonstration project ended March 27, the evaluation report revealed difficulties with medically unnecessary services or settings. Services or settings that RACs deemed unnecessary accounted for more than 40% of the $992.7 million in Medicare overpayments they uncovered during the pilot run. This category includes claims for services a provider renders in medically unnecessary settings, such as an admission for inpatient care when the patient required only outpatient care.

Direct-to-consumer genetic testing is a state matter
California began cracking down on direct-to-consumer genetic testing companies in June. The state’s Department of Public Health (DPH) sent cease-and-desist orders to 13 companies, requiring them to stop providing genetic testing to consumers.

Hectic ERs present audit challenges, compliance risks
The emergency room (ER) is among the most frantic and fast-paced areas in the hospital. Doctors and nurses are under intense pressure to make split-second, life-saving decisions. Not surprisingly, compliance is usually the last thing on their minds, which is exactly why auditing ER visits is so important.

Is your facility prepared for disaster?
Disasters are not exclusive to any one area. Some areas may be more susceptible to tornados, earthquakes, hurricanes, and floods, external risks exist elsewhere in the form of crime, fire, and bioterrorism.

Imaging accreditation will be mandatory in 2012
Your imaging facility is on the clock. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), which was passed in July, calls for providers of advanced diagnostic imaging services (e.g., MRI, CT, PET, and nuclear medicine) to be accredited by January 2012 in order to receive payment for the technical component of those services.

Other recently-published articles from Strategies for Health Care Compliance:

Increased focus on quality calls for more queries

Chargemaster maintenance is worth it

Quality of care is top priority in 2009

Tips for a successful switch to electronic health records

Q&A: HIPAA breach notification, secure e-mail, and more

Step up HIPAA compliance through auditing measures

Quality control, compliance in the genomics era

MS-DRGs are on the OIG’s radar

No compliance worries here

Examine short stays, avoid overpayment

Direct-to-consumer genetic testing is a state matter

Hectic ERs present audit challenges, compliance risks

Is your facility prepared for disaster?

Imaging accreditation will be mandatory in 2012

ICD-10 is coming: Educate physicians and IT, not just coders

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