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Health Care Auditing Strategies

Issue 12, December 1, 2005

• Expect patient backlash from Part D

  Hospitals must bill self-administered drugs to outpatients Hospital outpatient departments...

Issue 12, December 1, 2005 - VIEW THE FULL ISSUE

• Verify that your hospital's cost reports reflect accurate wage data

  Let's fact it: If you don't have much experience looking at cost reports, the term "cost report...

• Giving IT tools to docs may defy anti-kickback rules

  Consider what might be wrong with the following scenario: A hospital provides a nonstaff physician...

Issue 11, November 1, 2005 - VIEW THE FULL ISSUE

• Enable managers to monitor their own departments for compliance

  As a hospital auditor, you can't possibly root out every potential risk area in your facility...

• Audit clinical trials to prevent patient safety violations

  Editor's note: This is the second in a two-part series. If you want to hunt down patient safety...

• Develop a plan for determining fair market value

  Chances are, you know physicians and administrators who are less than thrilled about documenting...

• When auditing clinical trials, look out for subtle nuances

  The Common Rule provides a number of protections for human research subjects. A fundamental right...

Issue 10, October 1, 2005 - VIEW THE FULL ISSUE

• Regulators target quality-of-care violations to find false claims

  A Pennsylvania hospital has agreed to pay $200,000 to settle charges that employees used improper...

• Add lifetime reserve days to your list of top audit priorities

  A patient lies in a hospital intensive care unit. Her coma has lasted for 85 days-nearly three...

• Audit outpatient cardiac rehab to verify compliance

  Outpatient cardiac rehab areas must have a physician stationed nearby at all times-on-call code...

• Follow these steps for auditing clinical trials

  Editor's note: This is part one of a two-part series. If your facility conducts clinical...

Issue 9, September 1, 2005 - VIEW THE FULL ISSUE

• Watch those discharges: Postacute care transfer changes occur Oct. 1

  Whether your hospital is ready or not, October 1 marks the beginning of a new era, one that won't...

• Improve accuracy in the cath lab

  How documentation review saved one hospital $6 million It's a situation that's all too familiar...

• Are you ready for a clinical repository to support EHR?

  Answer these questions to see how your facility measures up Wouldn't it be nice if setting up a...

• Minimize risk in the age of wireless healthcare

  It's common sense. Two people in an empty room can communicate in whispers. But when 100 other...

Issue 8, August 1, 2005 - VIEW THE FULL ISSUE

• Court rules birth center newborns are entitled to EMTALA screening exams

  Consider this question: A woman is admitted to a hospital birthing center. She gives birth to a...

• California to give Medicare fraud tipsters up to $1,000 for leads

  Smalltime whistleblowers who provide information about schemes to defraud California's healthcare...

• Eleven tips to prevent errant inpatient admissions

  A patient reports to your hospital on a Saturday afternoon with lightheadedness and nausea. Your...

• Experts: Scrushy acquittal won't affect impact of SOX

  Weeks ago, pundits predicted that the trial of HealthSouth founder Richard Scrushy would reveal the...

• Ensure accurate charity application processing

  Ensure that your facility consistently processes charity-care applications following its mission...

Issue 7, July 1, 2005 - VIEW THE FULL ISSUE

• Verify that your staff know how to verify immigrant status

  The federal government will give hospitals money this year to offset the cost of treating illegal...

• Having trouble finding a few good auditors? You're not alone

  Filling an open healthcare auditor position isn't easy. Depending on the position, a candidate...

• One hospital's media relations solution to HIPAA

  Editor's note: This article is the second in a two-part series about handling media risk. For...

• Conduct an audit of observation nursing services

  Verify correct coding and charging of bedside procedures Hospitals often fail to code or...

• Out-of-control physicians create risk for your hospital

  They're abusive, short of temper, and degrading to employees. They may have impeccable...

Issue 6, June 1, 2005 - VIEW THE FULL ISSUE

• Monitor restraint abuses to avoid false claims accusations

  Patients have the right to be free from medically unnecessary restraints, or those administered by...

• Gainsharing may save money, but proceed with caution

  Financial leaders at your facility may be chomping at the gainsharing bit, now that the OIG has...

• Be prepared to speak with the media in a crisis

  Editor's note: This article is the first in a two-part series about handling media risk. Part two...

• Improve your facility's medical necessity compliance

  If there's one area of compliance the government will watch for years to come, you can bet on...

Issue 5, May 1, 2005 - VIEW THE FULL ISSUE

• Sentencing guidelines: What the new interpretation means for compliance

  In January, the U.S. Supreme Court reached a watershed decision, declaring the federal sentencing...

• New auditors contracted by CMS will get a percentage of findings

  Scrutinizing thousands of Medicare claims forms would be a daunting task. However, receiving a cut...

• Prioritize your risk assessment in 11 easy steps

  Review the OIG Work Plan, meet with external auditors, and stay up to date with local and national...

• Transplant centers: A high-risk area for billing mistakes

  When you turn over a rock, you never know what will crawl out from underneath. For compliance...

Issue 4, April 1, 2005 - VIEW THE FULL ISSUE

• Create a policy for physician interactions with drug reps

  You may think drug sales representatives no longer lavish physicians with expensive trips and...

• Prepare for HIPAA security compliance deadline this month

  According to Phoenix Health Systems, a consulting company that provides healthcare information...

• Troubleshoot your hospital's stent procedures

  To keep up with one of the OIG's top priorities, verify that your hospital's cardiac stent...

• Follow these seven steps to hospital compliance

  Understanding the law. Performing a risk assessment. Educating staff. These are all aspects of your...

Issue 3, March 1, 2005 - VIEW THE FULL ISSUE

• Monitor OxyContin prescriptions to prevent OIG crackdowns

  The OIG is cracking down on physicians who prescribe too much OxyContin®, which means your...

• Audit vendors to keep feds away

  If your organization outsources billing and coding to a vendor, don't assume that the vendor is...

• CRNAs: A smart place to check for compliance

  Chances are, certified registered nurse anesthetists (CRNA) at your hospital require physician...

• Verify that your ER meets EMTALA compliance

  Flexibility, cooperation, and organization: An emergency room (ER) needs these characteristics to...

• Nail your next board presentation with these tips

  Let's face it: Healthcare compliance involves a lot more than tracking codes and keeping up with...

Issue 2, February 1, 2005 - VIEW THE FULL ISSUE

• There seems to be a problem-Now what should I do?

  It may be the hardest part of an auditor's or compliance officer's job-deciding what to do when...

• Anti-kickback statute: Stay alert to current regulatory trends

  You already know to steer clear of kickback arrangements, but you must remember that the...

• Five tips to conquer your security risk assessment

  Although the Joint Commission on Accreditation for Healthcare Organizations (JCAHO) requires...

• What's up ahead on the compliance horizon?

  Clinical research, unnecessary medical procedures, and information technology: If you're trying to...

• Make global changes now to save time later

  To trim wasted minutes and minimize mistakes, take the time to periodically evaluate your...

Issue 1, January 1, 2005 - VIEW THE FULL ISSUE

• Vendors: Audit purchasing and materials management contracts

  Vendor contracts for equipment and supplies represent a significant portion of a healthcare...

• Strategies for monitoring and auditing HIPAA compliance

  Auditing and monitoring are essential to ensuring HIPAA compliance. An effective auditing and...

• How to preserve attorney-client privilege

  Healthcare organizations that conduct internal investigations face two overriding needs: the need...