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Stop readmissions when you can: CMS plans to eliminate unnecessary return visits
In April, CMS announced the beginning of a pilot project called Care Transitions, aimed at...
California’s hospital quality data reporting success
These days, quality and care are buzzwords, especially in the world of compliance.
Ten lessons learned from the RAC demonstration program
Editor’s note: The following is an excerpt from HCPro’s Revenue Institute Cycle blog...

OIG illustrates five principles of compliance
Although the government is cutting back on many programs while the recession continues, U.S...
Start blending quality into the compliance program
For years, quality and compliance have been two different tribes in the healthcare world. However...
Medicaid agency lays out eight elements for compliance
Since Medicaid programs are state-run, they vary across the country. However, New York has set a...
Avoid denials and lost revenue with internal audits
Evaluation and management (E/M) codes describe the complexity of the professional services a...
Auditors watch out for coding compliance issues
Evaluation and management (E/M) codes describe the complexity of the professional services a...
Operate an efficient auditing program
Coders have a moral and ethical responsibility to judiciously avoid reimbursement fraud and abuse...

Medical necessity important element of audits<
Every audit has unique components to check depending on whether you audit a certain department, a...
Understand how never events, HACs differ
On January 15, CMS announced three national coverage determinations (NCD) that aim to protect...
ED auditing includes many components
Among the chaos of the emergency department (ED) lie several unique compliance challenges and...

Know compliance risks before auditing
Coding for evaluation and management (E/M) services is no walk in the park for physicians...
Anesthesia audits require prior research, expertise
With sets of complex codes for anesthesia services from the AMA’s 2009 CPT Manual and the...
RACs are coming: Use these three strategies for success
The Recovery Audit Contractor (RAC) program will test your facility’s staffing requirements...
Outpatient clinics: Audit your facility’s tool
Providers often rely on guidance from governing healthcare agencies, namely CMS, to ensure proper...

Healthcare open to economic woes
As Americans suffer through a severe economic recession, healthcare professionals are discovering...
EHR compliance: Audit copy/paste function use
Almost anyone who uses a computer is aware of its copy and paste capabilities. You can use it to...
Clear up the confusion in drug/biologicals audits
Accurate coding and billing of drug and biological commodities is a detailed process.
Auditing watch: Keep an eye on pricey dialysis claims
Take dialysis as a prime example. As an expensive procedure, highly regulated by CMS, it is...

Make Stark compliance a priority this year
Upcoming changes to Stark Law should put financial arrangement audits at the top of compliance...
Don’t forget about Medicaid: 2009 OIG Work Plan highlights compliance concerns
The OIG characteristically included many Medicare reviews, audits, and investigations in its 2009...
Know the rule for billing inpatient-only procedures
Although the rule for inpatient-only procedures in an outpatient setting may initially seem rather...

Create a compliant on-call payment model
by Jen Johnson, CFA A shortage of on-call physicians makes it more important than ever to find an...
Ease your compliance worries: Get ready for 2009
With the government stepping up its efforts to combat Medicare and Medicaid fraud and abuse...
HCAS 2008 index
Auditing and monitoring Advance beneficiary notice audit plan. Dec., p. 8. Audit cath labs...