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Health Care Auditing Strategies

Issue 1, December 12, 2008

• Step up HIPAA compliance through auditing measures

  With the focus on enforcement increasing in many areas of healthcare compliance, auditors need to...

Issue 12, December 1, 2008 - VIEW THE FULL ISSUE

• Conquer EMTALA on-call provision challenges 

  The Emergency Medical Treatment and Active Labor Act (EMTALA) has been around for more than 20...

• Scrutiny of medical errors increases

  by Camella Boateng An estimated 44,000–98,000 American adults die each year from...

• New CMS rules for ABNs require auditing

  Beginning in March 2009, CMS will require Medicare Part B providers, including hospital outpatient...

• Lucrative cath labs raise red flags

  Cardiology catheterization labs are big moneymakers in hospitals. However, the potential for big...

• Three-day rule: Know the details to stay in compliance

  Some call it the three-day rule. Others call it the DRG preadmissions rule. Some say to-mat-o. Some...

Issue 11, November 1, 2008 - VIEW THE FULL ISSUE

• Work Plan focuses on quality

  The nine new audits for hospitals in the OIG’s 2009 Work Plan shows that the quality of care...

• RAC guinea pigs give glimpse of what’s to come

  As recovery audit contractors (RAC) start to spread across the country in a permanent CMS auditing...

• Proceed to EHR with caution, planning

  Slowly but surely, providers are moving toward adoption of electronic health records (EHR) in hopes...

• Three HACs added in IPPS rule

  With the release of its fiscal year 2009 inpatient prospective payment system (IPPS) final rule...

Issue 10, October 1, 2008 - VIEW THE FULL ISSUE

• Hectic ERs present audit challenges, compliance risks

  A fast-paced and often demanding environment makes the emergency room (ER) a unique challenge for...

• Beware when developing gift-giving policies

  “Buy one, get one free!” “Stay at our hotel and receive a free continental...

• Encoder software may lead to clinically inaccurate coding

  Encoder software used in hospital coding departments can lull coders into a false sense of security...

• Take a long-term approach to short-stay audits

  The Recovery Audit Contractor (RAC) demonstration project ended March 27, and providers are still...

Issue 9, September 1, 2008 - VIEW THE FULL ISSUE

• Clinical documentation programs result in fewer errors, improved compliance

  How can coders ensure that they assign the correct present-on-admission (POA) indicator? How can...

• Medicaid integrity contractor audits soon to follow RACs

  Worried about recovery audit contractors (RAC)? They are only part of the incoming dust storm of...

• Be prepared for RACs with internal audits

  Recovery audit contractors (RAC) arrive in 2010, so hospitals need to start preparing. Start by...

• Five tips to audit coders for compliant claims

  Physician documentation plays a big part of the billing process in medical facilities. But no...

• Timing is important when auditing observation status

  Some compliance mistakes never seem to go away, no matter how hard you try. "I would say it's a...

Issue 8, August 1, 2008 - VIEW THE FULL ISSUE

• CMS stops payment for eight HACs; more to come

  Beginning in October, hospital staff members need to be more conscious of patients' conditions at...

• A four-step approach to a risk management plan

  In an attempt to reduce government spending, state and federal agencies are taking a fine-tooth...

• Methods of issuing IM on discharge appeal rights vary

  Hospital staff members have a few choices when deciding how to distribute the Important Message...

• A proactive approach to self-disclosure

  The cost to healthcare organizations that do not comply with federal healthcare laws and...

• Conducting an internal investigation interview

  When conducting an internal investigation interview, don't try to mimic the television show Law and...

• CMP may serve as solution to patient status concerns

  Editor's note: This article is the second in a two-part series on patient status. Developing...

Issue 7, July 1, 2008 - VIEW THE FULL ISSUE

• New York's new work plan offers audit cheat sheet

  The detailed work plan released on April 22 by New York's Office of the Medicaid Inspector General...

• OIG increases oversight for Medicaid mental health

  The Deficit Reduction Act of 2005 (DRA) brought significant changes to reimbursement for medical...

• OIG attention on DSH payment program escalates

  The OIG has focused its attention on the Medicaid Disproportionate Share Hospital (DSH) Payment...

• Patient status: Five tools to conduct internal audits

  Editor's note: This article is the first in a two-part series on patient status. In an era of...

Issue 6, June 1, 2008 - VIEW THE FULL ISSUE

• EMTALA provides ongoing challenges, opportunities

  CMS released the newest revisions to the Emergency Medical Treatment and Active Labor Act of 1986...

• Three-pronged approach appropriate for quality concerns

  At the Health Care Compliance Association's (HCCA) Compliance Institute in May, quality of care...

• Examine FMV for physicians in administrative roles

  Placing physicians in paid positions for administrative roles requires great care because failure...

• Patients' Bill of Rights: How and when to abide by it

  When a medical facility runs into trouble regarding the Patients' Bill of Rights, more than likely...

Issue 5, May 1, 2008 - VIEW THE FULL ISSUE

• Get ready for RAC audits: Six tips to help you prepare

  CMS recently ended the demonstration phase of its recovery audit contractor (RAC) program and began...

• Time to prepare for present-on-admission investigation

  CMS completed its phased implementation of the present-on-admission (POA) reporting requirements...

• Myths and misconceptions to refute about the changing role of compliance officers and auditors

  In the past, compliance officers labored to ensure hospital bills were correctly coded. With the...

• Use internal audits to find Medicaid problems

  Today you need to worry about more than Medicare billing errors-Medicaid investigations are on the...

Issue 4, April 1, 2008 - VIEW THE FULL ISSUE

• Protect compliance practices

  A pending federal lawsuit against Tenet Healthcare Corporation's former general counsel and...

• Compliance's new frontier: The quality movement

  In the past few years, the compliance industry has received several powerful reports from...

• Use these tips and tools to tackle physician audits

  Regular auditing and analysis of physicians' evaluation and management (E/M) coding and...

Issue 3, March 1, 2008 - VIEW THE FULL ISSUE

• Control gift giving to prevent legal trouble

  Lavish catered lunches. Premium tickets to sporting events. All-expenses-paid trips to conferences...

• Six steps to improve HIPAA security audits

  If you are not on CMS' list of potential PricewaterhouseCoopers (PwC) HIPAA audits, be thankful...

• Tips to uncover triggers for internal investigations

  How do you know whether your facility should investigate a potential problem? The source of the...

Issue 2, February 1, 2008 - VIEW THE FULL ISSUE

• Audit cath labs effectively

  There's a lot riding on the accuracy of cardiac catheterization laboratory (cath lab) billing and...

• IPPS changes affect hospital compliance, reimbursement

  CMS implemented new hospital inpatient prospective payment system (IPPS) rules in October 2007 in...

• Compliance partners: Tips to win over the board

  You may have noticed increased attention from the board of directors and compliance board recently...

• Take a step-by-step approach to analyze bad debt

  Editor's note: This is the first article in a two-part series about auditing and managing bad debt...

Issue 1, January 1, 2008 - VIEW THE FULL ISSUE

• Changes to Phase III Stark regulations arrive to give guidance

  Phase III Stark regulations have arrived without the explosive changes some feared, but they still...

• CMS continues to concentrate on physical therapy community

  During the past few years, CMS peppered the physical therapy community with transmittals designed...

• The New Year: Complete your compliance resolutions

  Some say the arrival of the New Year offers the opportunity to wash away the mistakes of 2007 and...