Healthcare Outsourcing Trends: Advantages Of Outsourcing Healthcare Compliance
One of the most significant healthcare outsourcing trends is the movement to outsource activities not directly involved in the core…
UPICs are coming: Will you be ready?
Currently, the Centers for Medicare & Medicaid Services (CMS) use separate Medicare and Medicaid integrity contractors to predict, detect, prevent,…
Claim Processing in Healthcare: Steps for Effectively Monitoring, Billing, and Auditing to Manage Risk
Today, healthcare providers face increasing scrutiny of their claims processing system by regulatory agencies and auditors. Incorporation of claim processing…
Lessons Learned from the Two-Midnight Rule: Compliance Tips for Short Stay Claims Reviews
Over the past year, there has been a growing controversy over the impact the Two-Midnight Rule will have on hospitals…
Claims Processing Ongoing Monitoring and Auditing: Improves Revenue and Prevents Costly Errors
The Medicare administrative contractors (MACs) continue to question claims. ย The zone program integrity contractors (ZPICs) seek pattern errors suggesting fraud…
Tips on Developing Compliance Policies and Procedures
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued a number ofย compliance program…
The WellCare Investigation Saga Is Coming to a Close
One of the major enforcement sagas inย managed careย came to a head on May 19th,ย when Todd S. Farha, former chief executiveย officer…
Interstate Medical Licensure Effort Advances
It was reported in HealthLeaders Media on September 17, 2014[1] that at least 15 states are considering a revised draft…
Medicare Advantage Organizations Were Improperly Paid Millions of Dollars for Unlawfully Present Aliens
The Office of Inspector General (OIG) is conducting a series of reviews examining Medicare payments made on behalf of individuals who are…
A Primer on CMS-Regulated Accountable Care Organizations
The Centers for Medicare & Medicaid Services (CMS) defines an Accountable Care Organization (ACO) as a group of doctors, hospitals,…
2014 Second Quarter OIG Enforcement Actions Against Organizations That Hire Excluded Individuals
The Department of Health and Human Services Office of Inspector General (OIG) reported during the second quarter of 2014, two…
Developing and Operating a Hotline: What You Need to Know
A hotline is a critical part of any effective compliance program. It is an important avenue of communication between employees…