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Health Care Auditing Strategies

Issue 7, July 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 6, June 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 5, May 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 4, April 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 3, March 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 2, February 1, 2009 - VIEW THE FULL ISSUE

• 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...

Issue 1, January 1, 2009 - VIEW THE FULL ISSUE

• 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...