“With Donald J. Trump set to return to the White House in January, the healthcare industry should expect to see changes in the enforcement of the Rule.”
Continue readingThe HIPAA Reproductive Health Rule: A Potential Plot Twist
Building a Quality Education Program That’s Good Enough
“The first thing that you should understand is this: you don’t have to build the perfect program. Your education program just needs to be good enough to ensure employees have the training needed to demonstrate core knowledge and pass audits and inspections.”
Continue readingEnsuring 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 readingHow the OIG’s New General Compliance Program Guidance (GCPG) Addresses the Seven Elements
“Compliance officers can make the most of the new GCPG to meet the requirements of the OIG’s seven elements in a relevant and meaningful way.”
Continue readingKey Takeaways from OIG’s New General Compliance Program Guidance (GCPG)
“Throughout the GCPG, helpful revisions and clarity are provided to a few areas that have proven problematic over the years.”
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.”
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