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“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.”
“While youth intervention is not a traditional focus for compliance professionals, they have a vital role to play here. Ensuring that assessment tools are easily available for pediatric providers is critical.”
“In the business of healthcare, promoting a culture of compliance is not merely a goal – it’s a necessity. There has to be a commitment throughout all levels of an organization to do the right thing and do things right. The organization needs to have a compliance culture that is contagious.”
“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.”
“We’re continually being asked for advice to help our healthcare leaders. Essentially, we are acting as a customer service representative. For that reason, if you want to improve the culture of compliance and get those leaders’ buy-in, then make sure you’re delivering great service when consulting to them.”
“This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct. It also emphasizes training individuals on how to recognize and report FWA violations when they see them.”
“As a compliance officer, you undoubtedly manage a multitude of simultaneous projects of different scope, size, and duration. It isn’t always easy, but it is worthwhile to continuously evaluate your project management methodologies and look for ways to enhance your skill set.”
“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.”
Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”