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Health Care Auditing Strategies

Issue 12, December 1, 2007 - VIEW THE FULL ISSUE

• Make smart use of new OIG Work Plan

  The OIG posted its 92-page plan on October 1 detailing what areas the OIG expects to audit in the...

• 'Present on admission' rule makes documentation vital

  Medicare doesn't want to pay hospitals to treat problems patients developed due to their stay at a...

• RACs are headed your way

  One rehabilitation hospital in California offers a glimpse of what might be your future: It has two...

• CMS offers guidance on DRA's effect on false claims

  CMS has issued two sets of guidance on section 6032 of the Deficit Reduction Act of 2005 (DRA) in...

Issue 11, November 1, 2007 - VIEW THE FULL ISSUE

• Take action to avoid CCAs, CIAs

  When healthcare providers find themselves in legal trouble, they often also find themselves saddled...

• Incorporate EMTALA into ongoing audits, compliance activities

  Litigation against hospitals relating to patient care often include claims of Emergency Medical...

• 2008: The year of Medicaid compliance enforcement

  Healthcare auditing and compliance professionals will be busy next year, says Jim Sheehan. As New...

Issue 10, October 1, 2007 - VIEW THE FULL ISSUE

• Mandatory Stark survey on its way

  Hundreds of hospitals will soon receive a notification from CMS they can't afford to ignore: It...

• Continuum Health makes HIPAA awareness a top compliance concern

  Few principles in medicine are more sacred than keeping patient information private. The legal...

• Stark II Phase III released

  Editor's note: This article first appeared courtesy of HCPro's breaking news e-mail service. As...

• Audit physicians for E/M missteps

  Physicians are overloaded with tasks-from staying on top of the latest medical advances to breaking...

• Kaiser to complete compliance makeover

  Kaiser Permanente is confronting a high-profile, high-stakes overhaul of some of its auditing and...

Issue 9, September 1, 2007 - VIEW THE FULL ISSUE

• CMS to close loopholes in Stark Law

  On July 2, CMS proposed potentially far-reaching changes to Stark regulations as part of its annual...

• Proceduralists ensure compliance with specialized surgeries

  Practice makes perfect. This is the commonsense concept behind the increasingly popular strategy of...

• Top reasons to target E/M

  Evaluation and Management (E/M) coding continues to be a top compliance priority. But an E/M audit...

• Learn from CMS' mistakes to guarantee outlier compliance

  It's time to pay attention to outpatient outlier payments. CMS didn't, and it became the subject of...

Issue 8, August 1, 2007 - VIEW THE FULL ISSUE

• As dust settles, health system's new vendor policy stands its ground

  If you've attended a healthcare compliance conference within the past year, chances are you've...

• Review your community benefit policy

  A number of policymakers in recent years have intimated that the community benefit standard is...

• Protect your quality of care

  On June 1, nurses from California-based Sharp HealthCare filed a 140-page quality-of-care complaint...

• Improve your facility's compliance through EHRs

  Silos characterize care delivery in the United States. Primary care physicians often are the first...

• Keep an eye on the incoming 'boom'

  Editor's note: This is the second part in a two-part series. Last month, HCAS wrote about the...

Issue 7, July 1, 2007 - VIEW THE FULL ISSUE

• Avoid unwanted surprises by conducting security risk assessments

  Expert: "Do you know where your vulnerabilities are?" It's impossible to read any current health...

• Baby boomers headed your way

  It's time to batten the hatches, as what some are referring to as the next "tidal wave" in...

• OIG targets hospitals for accurate vendor-rebate reporting

  If you peruse the OIG audit-report notifications that appear frequently in your e-mail inbox, you...

• SEC approves new guidance designed to make SOX compliance more feasible

  The Securities and Exchange Commission (SEC) approved new guidance in late May intended to ease...

Issue 6, June 1, 2007 - VIEW THE FULL ISSUE

• Take 'medically unnecessary' out of your facility's vocabulary

  Medical necessity is an area the OIG first addressed in the early 1990s, and it has yet to drop off...

• RAC program to go national by 2010

  CMS has announced that the recovery audit contractor (RAC) program will expand nationwide in two...

• Follow these twelve steps to create an effective compliance structure

  Although auditors and compliance officers may be the "go-to" people for compliance issues, there is...

Issue 5, May 1, 2007 - VIEW THE FULL ISSUE

• Alert: OIG auditing HIPAA security

  As you sit down at your desk, you see a pile of mail sitting in front of you. You start to panic...

• CMS proposes rule that may affect providers' training costs

  CMS published in the February 1 Federal Register the "Hospital Direct and Indirect Graduate Medical...

• Follow these tips to comply with the Deficit Reduction Act

  When the Deficit Reduction Act (DRA) became law in February 2006, your workload expanded to include...

• Whistleblower laws cause states to scramble for their own

  The OIG last month gave its stamp of approval to the false claims statutes for both Hawaii and...

Issue 4, April 1, 2007 - VIEW THE FULL ISSUE

• Audit your facility's ambulance rates to prevent inappropriate discounts

  Auditing a healthcare facility is no easy task, and it's embarrassing when something falls through...

• Case study: Auditing firm uses multiple methods to train auditors

  In today's fast-paced, highly regulated world of healthcare auditing, staying up to speed with the...

• Consider the OIG when auditing cardiac rehab programs

  When auditing your cardiac rehabilitation program's compliance with billing and coding regulations...

• Be sure your facility is prepared for the new UB-04

  Now that the beginning of the year has passed, it's time to focus on one major change that will...

Issue 3, March 1, 2007 - VIEW THE FULL ISSUE

• Help physicians avoid the median coding by auditing for accuracy

  Editor's note: This story was written by Michael G. Calahan, PA, MBA, CCS-P, CPC, CPC-H, BAMC-OP...

• Follow HCCA's tips to ensure compliance with the government

  The OIG has released its planned investigations for 2007 as part of its annual Work Plan. As...

• When in doubt, turn to CMS

  How to request an advisory opinion from CMS, rather than the OIG The complexities of the...

Issue 2, February 1, 2007 - VIEW THE FULL ISSUE

• Physician practice: Audit to verify compliance, efficiency

  Audits can help you to determine whether you are achieving your physician clinic's goals and...

• Health system nixes freebies, implements strict regulations

  The Henry Ford Health System in Detroit will no longer accept free gifts, lunches, and other perks...

• CMS seeks insight regarding its new national patient assessment instrument

  New tool will provide uniform payment system for multiple healthcare facilities CMS and its...

• CMS' Conditions of Participation revision could mean back to the drawing board

  Agency makes changes to H&Ps, verbal orders, security of medication, and postanesthesia...

Issue 1, January 1, 2007 - VIEW THE FULL ISSUE

• Not getting correct reimbursements?

  Congress. The OIG. Fiscal intermediaries. CMS. They all have some say in how reimbursement flows...

• Know the difference between bundling and packaging to ensure compliance

  When it comes to "packaging" and "bundling" services, coders within your organization may be...

• Case study: Meet Joe Rivet

  Somewhere in the middle of one of Michigan's largest health systems sits Joe Rivet, CPC, CCS-P...

• New Year's resolutions

  When it comes to making a New Year's resolution, some will choose to lose weight, others may...

Issue 34, September 11, 2007

• Featured audit plan: Ambulatory payment classification monitoring

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

Issue 32, August 28, 2007

• Pay-per-view: Proceduralists ensure compliance with specialized surgeries

  Practice makes perfect. This is the commonsense concept behind the increasingly popular strategy of...