“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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“Revenue cycle management compliance is crucial for the financial health and operational success of healthcare providers. By adhering to regulatory standards, ensuring accurate billing and coding, and protecting patient information, healthcare facilities can avoid legal repercussions and maintain patient trust.”
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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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“The cost of non-compliance in healthcare extends far beyond fines and penalties. It encompasses legal fees, reputational damage, operational disruptions, and more. Investing in compliance is not just a legal obligation—it is a critical component of a healthcare organization’s operational excellence and commitment to patient care.”
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“Before moving on from 2023, it is important to take time and get feedback from business partners to ensure an “outside-in” perspective is included in your 2024 plan.”
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“Successful compliance programs are adapted to fit the organization and maximize compliance for individual organizations with unique risk profiles.”
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“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.”
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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.
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“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.”
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