“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 reading
“We’re continually being asked for advice to help our healthcare leaders. Essentially, we are acting as a customer service representative. For that reason, if you want to improve the culture of compliance and get those leaders’ buy-in, then make sure you’re delivering great service when consulting to them.”
Continue reading
“This three-pronged strategy focuses on educating patients and staff about how to avoid misconduct. It also emphasizes training individuals on how to recognize and report FWA violations when they see them.”
Continue reading
“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 reading
“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 reading
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 reading
If we want to improve our organizations’ compliance culture, then we need to interact with our healthcare leaders in a way that sells compliance without “selling” compliance.
Continue reading
A “reframe, regroup, refocus” approach enables compliance teams to work with other departments to provide excellent patient-centered care.
Continue reading
“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.”
Continue reading