HCPro.com - Health Care Auditing Strategies

Ten lessons learned from the RAC demonstration program

Wed, 01 Jul 2009 14:50:00 GMT

Editor’s note: The following is an excerpt from HCPro’s Revenue Institute Cycle blog. Visit www.revenuecycleinstitute.com for more.

California’s hospital quality data reporting success

Wed, 01 Jul 2009 14:48:00 GMT

These days, quality and care are buzzwords, especially in the world of compliance.

Stop readmissions when you can: CMS plans to eliminate unnecessary return visits

Wed, 01 Jul 2009 14:45:00 GMT

In April, CMS announced the beginning of a pilot project called Care Transitions, aimed at eliminating unnecessary hospital readmissions.

Healthcare Auditing Strategies, July 2009

Wed, 01 Jul 2009 14:43:00 GMT

In this last issue of Healthcare Auditing Strategies, we’ll take a look at unnecessary hospital readmissions, what CMS is doing to eliminate them, and what you can do to avoid claims denials at your facility. We’ll also learn about California’s new quality measuring program, and hear about the top lessons learned from participants of the recovery audit contractor demonstration program.

Healthcare Auditing StrategiesJune 2009

Mon, 01 Jun 2009 14:01:00 GMT

This month in Healthcare Auditing Strategies, we’ll take a look at some of the issues compliance professionals talked about at this year’s Healthcare Compliance Association Compliance Institute, including a summary of Inspector General Daniel Levinson’s keynote speech. We’ll also examine evaluation and management auditing and seven coding traps auditors need to watch out for when performing coding audits.

OIG illustrates five principles of compliance

Mon, 01 Jun 2009 14:01:00 GMT

Although the government is cutting back on many programs while the recession continues, U.S. Department of Health and Human Services (HHS) Inspector General Daniel Levinson wants compliance officers to know healthcare compliance funding is not going away.

Start blending quality into the compliance program

Mon, 01 Jun 2009 14:01:00 GMT

For years, quality and compliance have been two different tribes in the healthcare world. However, with the growing concern about quality issues such as hospital-acquired conditions, present-on-admission conditions, and never events, the link between quality and compliance is becoming clearer.

Medicaid agency lays out eight elements for compliance

Mon, 01 Jun 2009 14:01:00 GMT

Since Medicaid programs are state-run, they vary across the country. However, New York has set a high standard, becoming the first state to create its own Medicaid work plan and recovering more than $250 million in damages and restitution related to cases of fraud and abuse in 2008.

Avoid denials and lost revenue with internal audits

Mon, 01 Jun 2009 14:01:00 GMT

Auditors watch out for coding compliance issues

Mon, 01 Jun 2009 14:01:00 GMT

Evaluation and management (E/M) codes describe the complexity of the professional services a provider renders during a visit. These codes represent office, hospital, and nursing home visits, as well as consultations and other nonprocedural services. You can locate the codes in your CPT Manual. There are currently two sets of E/M coding guidelines published jointly by CMS and the AMA:

1995 Documentation Guidelines for Evaluation and Management Services
1997 Documentation Guidelines for Evaluation and Management Services

Operate an efficient auditing program

Mon, 01 Jun 2009 14:01:00 GMT

Coders have a moral and ethical responsibility to judiciously avoid reimbursement fraud and abuse at their facilities.

Healthcare Auditing StrategiesMay 2009

Fri, 01 May 2009 14:01:00 GMT

This month in Healthcare Auditing Strategies, we’ll closely examine the differences between never events and hospital-acquired conditions (HACs), what HACs are also never events, and what regulations go along with never events and HACs. We’ll also take a thorough look at the many components of an emergency department audit—we’ve included a sample audit plan that will help ensure compliance with the Emergency Medical Treatment and Labor Act of 1986.

Medical necessity important element of audits<

Fri, 01 May 2009 14:01:00 GMT

Every audit has unique components to check depending on whether you audit a certain department, a specific type of service, or a particular type of coding. But one thing these audits have in common is the need to examine medical necessity.

Understand how never events, HACs differ

Fri, 01 May 2009 14:01:00 GMT

On January 15, CMS announced three national coverage determinations (NCD) that aim to protect patients from paying for preventable surgical errors. These three policies are the most recent steps in CMS’ initiative to highlight patient safety in hospitals and to reduce the incidence of never events—28 serious reportable events the National Quality Forum

ED auditing includes many components

Fri, 01 May 2009 14:01:00 GMT

Among the chaos of the emergency department (ED) lie several unique compliance challenges and risks. However, along with this risk, there is the potential for improved revenue if staff members correctly follow proper procedures and policies.

Healthcare Auditing StrategiesApril 2009

Wed, 01 Apr 2009 14:01:00 GMT

This month in Healthcare Auditing Strategies, we go in depth on E/M services audits, outlining several tips and steps you can use in your next E/M audit. HCPro Regulatory Specialist Joe Rivet, as we as compliance professionals from Trinity Health in Michigan will offer firsthand experience and advice. We’ll also take a look at the complex world of anesthesia in an article that highlights the coding and billing challenges found in this department.

Know compliance risks before auditing

Wed, 01 Apr 2009 14:01:00 GMT

Coding for evaluation and management (E/M) services is no walk in the park for physicians. Selecting the correct code from the appropriate category isn’t exactly foremost on physicians’ minds, as they’re often directing their focus on quality patient care. Nonetheless, providers must submit proper claims to avoid fraud and earn a living, which makes auditing for accurate E/M coding a high priority.

Anesthesia audits require prior research, expertise

Wed, 01 Apr 2009 14:01:00 GMT

With sets of complex codes for anesthesia services from the AMA’s 2009 CPT Manual and the American Society of Anesthesiologists (ASA), coupled with a need for detailed documentation, anesthesia audits require serious planning.

RACs are coming: Use these three strategies for success

Wed, 01 Apr 2009 14:01:00 GMT

The Recovery Audit Contractor (RAC) program will test your facility’s staffing requirements and, in many cases, your patience. But with an effective revenue cycle management process, a clean chargemaster, and effective auditing and monitoring within your facility, such concerns can be easily identified and corrected before a RAC can retrieve prior reimbursement.

Outpatient clinics: Audit your facility’s tool

Wed, 01 Apr 2009 14:01:00 GMT

Providers often rely on guidance from governing healthcare agencies, namely CMS, to ensure proper protocol in their business. However, such agencies are not always 100% clear, making compliance more difficult. Billing and coding in outpatient clinics is an example of an area in which compliance guidance hasn’t been cut and dry.