“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations with unique risk profiles.”
Continue readingKey Takeaways from OIG’s Newly Released General Compliance Program Guidance
The Value of “Operationalizing” Your Compliance Program
“Regardless of the business model, there’s been one common reason why these organizations were successful in “operationalizing” their compliance programs: compliance priorities were aligned with business objectives and priorities. And the operations leaders bought in.”
Continue readingReversing Conventional Thinking About Compliance
Explore how compliance professionals can prove their true value in organizations, dispel misconceptions, and effectively mitigate risks. Real-world examples illustrate the tangible impact of robust compliance departments.
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 readingEmbrace Your Role as a Healthcare Compliance Project Manager
“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.”
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 readingSignificant Upcoding Risks Emerge with Medicare Advantage
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.”
Continue readingTelehealth Enforcement Actions
“It behooves all healthcare compliance professionals to be aware of the fraud, waste and abuse risks associated with telehealth services. This mode of delivery holds great promise. For it to fulfill that promise, non-compliance needs to be rooted out and corrected.”
Continue reading