The revenue cycle is the process that starts with a patient’s initial appointment and ends with full payment for services. It encompasses all the administrative and clinical functions that contribute to collecting patient service revenue. For healthcare organizations that provide services to patients, the revenue cycle is the organization’s financial lifeblood.
Continue readingExclusion Screening Failure Causes Compliance Nightmare
In Q3, the exclusion screening software glitched. It missed a monthly sync. Then a second. By the third missed month, the compliance officer dismissed it as “a minor lag,” promising the HR department everything would be rerun soon.
Unfortunately, even a seemingly small glitch can have major consequences for healthcare compliance.”
Continue readingWhat Happens When Integrity and Accountability Fail: Lessons for Compliance Professionals
“The U.S. opioid epidemic holds important lessons for compliance professionals. This public health crisis is characterized by the widespread misuse of opioid drugs, leading to addiction, overdose deaths and a profound social and economic toll.
This epidemic has evolved over the past few decades, and while there are many contributing factors, the role of pharmaceutical companies, particularly in the early stages, is widely seen as a critical element.”
Continue readingBreaking Down the OIG’s First Industry-Specific Guidance
“Compliance professionals at nursing facilities and their business partners should regularly study the ICPG as they continue their compliance efforts.”
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 readingRevenue Cycle Management Compliance: Ensuring Financial Health in Healthcare
“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.”
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 readingThe Cost of Non-Compliance
“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.”
Continue readingReady, Set, Go! Identifying Emerging Risks in Your 2024 Compliance Workplan
“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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