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11 Educational Resources on Revenue Cycle and Healthcare Compliance

11 revenue cycle resources for compliance blog header

Revenue leakage from non-compliance with regulations exposes health systems to compliance risks and penalties. We’ve curated eleven resources to help compliance leaders be better prepared to guide alignment between regulatory compliance processes and revenue integrity goals.

Over half of all regulations deal directly with revenue cycle, billing and finance. Most providers still lack an effective system or process to monitor, assess, and validate compliance with those regulations. As a result, these organizations leave themselves open to significant risks, not to mention significant revenue leakage.

These resources are a great place to start learning more about the revenue angle of healthcare compliance.

OIG Cites Fraud, Waste and Abuse Concerns with Skin Substitutes

Many compliance professionals rely on HHS OIG focus areas as they perform risk assessments and plan subsequent auditing and monitoring activities. In November 2024, the OIG added an item to their Work Plan describing their intention to review Medicare Part B payments for skin substitutes.

This blog explores the implications for compliance and what health systems need to be aware of.

billing OIG revenue cycle risk management

Three Strategies to Align Compliance with Revenue Cycle

The revenue cycle is the process that starts with a patient’s initial appointment and ends with full payment for services. It encompasses all the administrative and clinical functions that contribute to collecting patient service revenue.  For healthcare organizations that provide services to patients, the revenue cycle is the organization’s financial lifeblood.

billing Compliance Culture How to OIG revenue cycle TIP SHEET Tips

Exclusion Screening Failure Causes Compliance Nightmare

In Q3, the exclusion screening software glitched. It missed a monthly sync. Then a second. By the third missed month, the compliance officer dismissed it as “a minor lag,” promising the HR department everything would be rerun soon.

Unfortunately, even a seemingly small glitch can have major consequences for healthcare compliance.”

board of directors OIG regulatory change management revenue cycle risk management

What Happens When Integrity and Accountability Fail: Lessons for Compliance Professionals

“The U.S. opioid epidemic holds important lessons for compliance professionals. This public health crisis is characterized by the widespread misuse of opioid drugs, leading to addiction, overdose deaths and a profound social and economic toll.

This epidemic has evolved over the past few decades, and while there are many contributing factors, the role of pharmaceutical companies, particularly in the early stages, is widely seen as a critical element.”

OIG revenue cycle Tips

Breaking Down the OIG’s First Industry-Specific Guidance

“Compliance professionals at nursing facilities and their business partners should regularly study the ICPG as they continue their compliance efforts.”

billing OIG Quality revenue cycle

How 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.”

How to payer revenue cycle TIP SHEET Tips

Revenue Cycle Management Compliance: Ensuring Financial Health in Healthcare

“Revenue cycle management compliance is crucial for the financial health and operational success of healthcare providers. By adhering to regulatory standards, ensuring accurate billing and coding, and protecting patient information, healthcare facilities can avoid legal repercussions and maintain patient trust.”

board of directors revenue cycle TIP SHEET Tips