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Health Care Auditing Strategies

Issue 12, December 1, 2006 - VIEW THE FULL ISSUE

• How to hire new auditors under today's standards

  The hiring boom that infiltrated the healthcare industry following the implementation of the...

• How to keep your organization from landing in hot water

  Fraud lawsuits involving major players in the healthcare industry (e.g., UnitedHealth, HealthSouth...

• Using data analyses to monitor for fraud and abuse

  Although there are several procedures that you can use to monitor for the identification and...

• Chargemasters: Keeping your numbers transparent

  A growing number of organizations-ranging from employers to consumer groups-want to see rising...

• CMS update: Hospital Open Door Forum

  Several changes are in store for your facility in 2007, according to a special Hospital Open Door...

Issue 11, November 1, 2006 - VIEW THE FULL ISSUE

• Work plan: Use the OIG as your guide

  With the arrival of the 2007 OIG Work Plan, it's time for you to begin developing your own work...

• 10 steps to more productive inquiries

  Let's face it: When employees see compliance officers and auditors coming, they're not always...

• NPI implementation: Take a two-phase approach

  Many organizations are preparing to transition from the existing legacy numbers to national...

• Monitoring: Steps for achieving department buy-in

  If you have ever tried to set up a new compliance-monitoring program, these complaints may sound...

• GME: Final rule changes policy on didactic time

  A final rule passed down from CMS may change the way hospitals are reimbursed for graduate medical...

Issue 10, October 1, 2006 - VIEW THE FULL ISSUE

• Follow these 10 basic steps to ensure quality audit results

  It happens all too often: You start a seemingly simple audit of whether patient records include...

• How to turn a compliance risk assessment into an audit plan

  For many busy professionals, keeping and updating a desk calendar is difficult enough-never mind...

• Follow these universal steps when planning any audit

  Before jumping in and beginning an audit, be sure that you understand the steps that are involved...

• Information protection: Audit for work force awareness

  Prevent social engineers from conning their way onto your data train Your organization probably...

Issue 9, September 1, 2006 - VIEW THE FULL ISSUE

• Audit executive pay to ensure compliance with nonprofit status

  Editor's note: This is the second of a two-part series on auditing your facility's tax-exempt...

• Get ready: The DRA 'revolution' is only four months away

  When describing the Deficit Reduction Act (DRA), healthcare regulators aren't afraid to use the...

• Make HIPAA auditing part of the compliance effort

  Your organization needs appropriate policies and procedures to comply with HIPAA's privacy rule...

Issue 8, August 1, 2006 - VIEW THE FULL ISSUE

• Evaluate your hospital's charity care policy to ensure tax-exempt status

  Editor's note: This is the first of a two-part series on auditing your facility's tax-exempt...

• When awaiting organ acquisition costs, go back a few years

  Your hospital's older cost reports-the ones that your FI has already approved-may be like ticking...

• Final rule on didactic time could change everything

  This month-despite objections from the academic and teaching community-CMS is poised to shake the...

• Drug administration 'rejection relief' coming to hospitals

  Expect modifier -59 claims processing help from CMS, FIs, according to new article When CMS...

• Bridge the gap between clinical and coding language

  Language differences can be one of the toughest hurdles to overcome when it comes to training...

Issue 7, July 1, 2006 - VIEW THE FULL ISSUE

• Use caution before claiming payments for resident off-site rotations

  When it comes to claiming resident time spent in nonprovider sites for reimbursement, your facility...

• 10 steps to audit compliance with the new cardiac rehab regulations

  As part of updating your facility with the changes to cardiac rehabilitation regulations, you...

• Anticipate the moves of OIG agents-before they arrive

  For a compliance officer or auditor, this scenario could be a living nightmare: OIG agents with a...

Issue 6, June 1, 2006 - VIEW THE FULL ISSUE

• Sheehan: Watch those consultants

  The government is cracking down on compliance violations of healthcare contractors and vendors, so...

• Be a 'hospital Houdini' when auditing

  Hospital outpatient services, charges, and coding come from many sources-which can make auditing a...

• Make HIPAA audit logging more than just data collection

  HIPAA requires that your organization establish controls that record activity in systems that...

• To root out risk areas, ask managers the right questions

  When conducting a risk assessment, one of the best ways to obtain information from your...

• How much training does the Deficit Reduction Act require?

  Many healthcare experts are advising providers to educate employees about the False Claims Act to...

• The DRA means big changes are ahead for providers

  The Deficit Reduction Act of 2005 (DRA) has major consequences for all providers of healthcare...

Issue 5, May 1, 2006 - VIEW THE FULL ISSUE

• Review ambulance medical necessity before the OIG audits your facility

  The OIG is watching this difficult compliance area If you work for a hospital, ambulance...

• Is your FI ready for CMS' final cardiac rehab rule? Now's the time to check

  CMS has expanded cardiac rehab coverage for three new groups of Medicare beneficiaries. But if your...

• Diagnostic testing: Follow the right set of regulations

  Hospitals and nonhospital settings, such as independent diagnostic testing facilities (IDTF), have...

Issue 4, April 1, 2006 - VIEW THE FULL ISSUE

• Injections and infusions: Understand recent changes to head off problems

  With 2006 drug administration CPT and HCPCS changes and unclear explanations from CMS, your...

• CMS plans long-awaited changes to cardiac rehabilitation regulations

  Within the next six months, hospitals will likely be allowed to relax their policies regarding...

• Confusion about code C8952: Audit for compliance

  If a patient receives two IV pushes of the same drug 20 minutes apart, should you charge for each...

• Audit for GME compliance to head off OIG investigators

  Verify that your facility correctly accounts for resident FTEs The OIG has asked the University...

Issue 3, March 1, 2006 - VIEW THE FULL ISSUE

• Curb compliance violations: Audit your facility's physician E/M coding

  Editor's note: This article is the first in a two-part series about conducting E/M audits. Next...

• Conduct your facility's audits with a dash of PEPPER

  Although the Hospital Payment Monitoring Program (HPMP) offers free tools to help hospitals reduce...

Issue 2, February 1, 2006 - VIEW THE FULL ISSUE

• Lead a new approach to admissions; improve accuracy and compliance

  Chances are, your facility assigns patients to "inpatient" or "observation" status in the following...

• Get started with auditing modifier -59

  When coders need to indicate that a provider performed two distinct services for the same person on...

• Avoid violating CIAs: Allocate necessary resources

  The OIG notified Miami's South Shore Hospitals and Medical Center in December 2005 that it intends...

• Try these four tips to improve chargemaster accuracy

  Keeping your hospital's chargemaster updated with the latest codes and services requires vigilance...

Issue 1, January 1, 2006 - VIEW THE FULL ISSUE

• Taking the plunge: Work toward SOX compliance before you have to

  Section 404 of Sarbanes-Oxley (SOX) has emerged as the "big nut" for public companies to crack. But...

• 2006 Work Plan focuses on dialysis care, billing

  The OIG takes aim at new technology payments, inpatient psych stays, and more The 2006 Work...

Issue 7, July 1, 2006

• Fine-tune your charity care policy with these 10 steps

  As the number of uninsured Americans continues to climb each year, the burden on providers to...

Issue 1, January 1, 2006

• Part D is a major OIG focus area, but should providers be concerned?

  OIG investigators plan to focus on Medicare Part D, according to the 2006 Work Plan , released...

Issue 1, June 9, 2006

• OIG penalizes two more hospitals for incorrect wage index reporting

  The OIG is requesting that two more hospitals submit revised cost reports. That brings the total of...