Systems Reviews versus Transaction Reviews — A Closer Look at a New Era of Mandatory Compliance
A New Era of Mandatory Healthcare Compliance Programs Compliance programs initially were voluntary in the healthcare industry. Eventually managed care…
Systems Reviews versus Transaction Reviews in CIAs: Takeaways for Compliance Officers
Most compliance officers do not have to face the scrutiny and challenges of operating a compliance program under a Corporate…
CMS RAC Audits: Complex Review Issues
Although the Centers for Medicare and Medicaid Services (CMS) implemented the Recovery Audit Contractor (RAC) as a permanent program over a year…
CIA Compliance And Independent Review Organizations: Where to Start in the Selection Process?
The heightened focus on health care fraud, waste, and abuse continues to evolve and steadily climb given political and fiscal…
New Compliance Officers Should Not “Buy a Pig in a Poke”
New compliance officers often inherit a host of problems. This article talks about how to avoid assuming ownership of these…
More Health Care Executive and Board Accountability on the Way
Under the “Responsible Corporate Officer” doctrine, officers are subject to both criminal and civil liability for corporate violations of statutes…
Sanction Screening OIG High Risk Priority
Given the high level of enforcement emphasis on this issue, hospitals need to make it a high priority to screen…
Don’t Let Money Go to Waste Learn to Bill Discarded Drugs Correctly
The Centers for Medicare & Medicaid Services (CMS) recently released Transmittal 1962 clarifying the use of modifier JW and how to…
Undercoding Is it Worth it?
What is the issue?Hospitals are undercoding the services and items furnished to beneficiaries in a continual effort to avoid federal audits.…
Why OIG RAT-STATS and Sampling are Hot
The Best Strategy for Health Care Entities Is One of Proactive Preparedness The Centers for Medicare & Medicaid (CMS) are…
How are ethics and regulations connected in the hospital setting?
This article addresses three questions: What are the ethical principles behind the ten major hospital regulatory categories? Can ethics and…
Clarifications to CMS’ Longstanding Three-day Rule
The Centers for Medicare & Medicaid Services’ (CMS’) three‐day rule, also known as the 72‐hour rule, has remained unchanged since its…