“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.”
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“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.”
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“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.”
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“Whether you’re resolving a complex billing issue, or advising your leadership team about a business proposal, the ability to effectively make decisions is a valuable asset for any compliance officer.”
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“Keep in mind that your healthcare leaders often will not be as knowledgeable about requirements in regulations or something else as you are. For that reason, what may seem like an obvious concern to you may not be so obvious to them. Be open to the fact a gap may exist, and give them grace if they made a decision that unintentionally creates an issue that needs to be corrected.”
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“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.”
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“By bridging the gap between “us” and “them,” compliance teams can transform the perception of compliance teams from being an obstacle into being a collaborative partner and member of their team.”
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“Handling tough feedback is never easy, and quickly challenges your ability to remain professional. With the right mindset and approach though, it can be a powerful asset for your growth and development.”
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“Code G2211, which can be added to specific E/M codes under certain circumstances, is now separately reimbursable by Medicare.”
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