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Medical Necessity: A Guide for Healthcare Compliance Leaders

This is the first article in a series on medical necessity — an area that many compliance programs struggle with. In this piece, we explain the medical necessity compliance risk in general, while subsequent articles highlight specific examples of enforcement actions experienced by medical providers such as hospitals and health systems.

Know the Compliance Risk for Certain Anesthesia Services

A good healthcare compliance program is all about reducing risk, both in patient care and in financial reimbursement. This detailed blog by compliance expert, CJ Wolf, will bring you up to date on the compliance risks associated with certain anesthesia services.

Audit billing OIG payer risk management

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

YouCompli Brings Unique Value-Creating Compliance Technology to Healthcare Payers

“YouCompli, the leading provider of SaaS healthcare compliance solutions, today announced that its flagship platform is now available for use by the payer side of healthcare organizations.”

payer regulatory change management

How Social Determinants of Health Influence Compliance Culture

Jay anstine social determinants of health influence compliance

“By being aware of how your leaders think, you will uncover social determinants of compliance and understand their potential impact on the organization. You can then respond and assist accordingly, or remove barriers to successful compliance deliverables.”

Compliance Culture payer regulatory change management