ABSTRACT Prior to the COVID-19 pandemic, medical providers were routinely audited by public and private payers. Since the pandemic, when many payers were forced to pay for expensive COVID-19 related testing and treatment, payer audits have increased. When a provider...
As we have seen since April 2021, we are still being influenced by the Great Resignation or the Big Quit. COVID-19 was a wake-up call for many people in general, but even more so for employees who were not satisfied with their current roles in the workplace. Employees...
These are recaps of what they report as some of the trends and realities of compliance today
The innumerable horror stories related to payer audits have given rise to a new trend of undercoding, by intent! Many providers would rather be safe than sorry, all in the name of keeping their good names off the radar. However, undercoding can backfire, resulting in...
The 21st Century Cures Act ("Cures Act") was approved by Congress in 2016 with the intent to provide electronic access, exchange, and use of health information across all different types of health care entities. On May 1, 2020, the Cures Act's final rule became...
On the day that President Biden was sworn into office, the public health emergency (PHE) was set to expire, but the Department of Health & Human Services extended the emergency declaration for another 90 days, to April 20, 2021. This represents the fourth time...
In a response to the healthcare community’s desire to lessen the administrative burden on HIPAA covered entities, the Office of Civil Rights (OCR) issued a request of information (RFI) in December of 2018. Two years later, after this RFI comment period closed, the OCR...
ELEMENTS may seem like an unusual name for a newsletter but for us, the word is pretty much of a North Star. We use the “7 Elements of Compliance “to guide everything we do. A little history by way of explanation. In the mid 1990’s the CDC, OSHA and other government...
A coding audit can be immensely stressful. Even though many practices do well, there are cases (some of them rather well known) involving fraudulent behavior which result in large recoupments and overpayment extrapolations. How well you’ll do depends at least in...