“The U.S. government has recently increased its focus on foreign influence in academic research – which some call ‘academic espionage.’”
Continue readingEnsuring Compliance for Academic Medical Centers
Ensuring Compliance for Radiology Services
“Radiology services have unique characteristics, and some unique compliance considerations that accompany them include compliance rules associated with physician orders, medical necessity, local coverage determinations, and teaching physician settings.”
Continue readingHow to Use TPE Plans for Compliance Auditing and Monitoring
“There’s another incredibly helpful resource that some might not be as familiar with: the list of services that Medicare Administrative Contractors (MACs) include in their Target, Probe and Educate (TPE) plan.”
Continue readingHow to Avoid False Claims Related to Medical Necessity
“There is no silver bullet to solving medical necessity risks as they relate to medical claims submitted to payers such as Medicare. That said, these tips can be a starting point for compliance programs who know they need to minimize their compliance risk around medical necessity.”
Continue readingHow to Properly Use the G2211 Evaluation and Management Code
“Code G2211, which can be added to specific E/M codes under certain circumstances, is now separately reimbursable by Medicare.”
Continue readingKey Takeaways from OIG’s Newly Released General Compliance Program Guidance
“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations with unique risk profiles.”
Continue readingNew, Stronger Evaluation and Management Upcoding Enforcement
“Earlier this year, regulators made the most significant changes to E&M documentation and coding guidelines in over two decades. They’re more complex than ever before, and enforcement actions are increasing.”
Continue readingIncreasing Enforcement of Modifier Codes
“Enforcement agencies like to “follow the money,” so to speak, and they often find it in medical claims submitted to government payors such as Medicare and Medicaid. This is why selecting appropriate modifier codes is essential for operating and being reimbursed compliantly.”
Continue readingRecent Telehealth Enforcement and How to Prepare
“As healthcare fraud, waste, and abuse continues to emerge, and poses more of a risk to organizational compliance, professionals should become familiar with some of the potential areas of noncompliance associated with telehealth.”
Continue reading