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Obey the Writing on the RAC Wall by Improving Medical Documentation

Like a broken record, health information management (HIM) professionals have repeatedly warned physicians and other clinicians about the importance of medical-record documentation by saying, "If it's not documented, it wasn't done!" With advancements and challenges such as the evolution of electronic health records (EHRs), complex reviews Read more

Post-Payment Probe Reviews’ Impact on RAC Investigations

Unsurprisingly, after the Obama administration pledged additional funding for 2012 fraud and abuse detection efforts, utilization and specialty audits have soared throughout the U.S. Physicians are receiving letters citing "Section 1842 (a)(1)(c) of the SSA requiring carriers under contract to the Centers for Medicare & Medicaid Read more

The Dos and Don’ts for Proper Attending Physician Documentation to Ensure Medical Necessity Compliance

As medical necessity continues to be a hot-button issue in the healthcare industry, getting the level of service correct every time is not only necessary, but critical in order to remain compliant with the Conditions of Participation (CoP) as set forth by the Centers for Read more

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This Week's Top Stories are sponsored by: Panacea Healthcare Solutions, LLC.

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Feb

2012

HIPAA Compliance Audits: The Newest Risk for Providers?

Written by Elizabeth Lamkin, MHA

Providers now have yet another form of oversight to worry about: the HIPAA Compliance Audit Program. In 2011, the Office of Civil Rights (OCR) extracted a few massive settlements and fines for HIPAA violations: Cignet Health paid a $4.3 million civil fine,¹ Massachusetts General Hospital paid a $1 million settlement,² and UCLA Health System paid an $865,000 settlement.³ Now, in 2012, we can expect many more to come.

Feb

2012

Stress on the Job Keeping Compliance Officers up at Night

Written by Karen Long

alert-powered-by-decision-health

Almost 60 percent of respondents to a recent Health Care Compliance Association survey report that they often wake up in the middle of the night because of job-related stress.

Keeping up with new regulations (24 percent), preventing violations (16 percent) and remediating compliance and ethics violations (14 percent) are the top reasons for the stress, the survey of more than 970 people stated.

Jan

2012

RACTrac Survey Reveals More Realities of Hospital Audits

Written by Kim T. Charland, BA, RHIT, CCS

Most of the medical-necessity denials uncovered by complex reviews conducted by recovery audit contractors (RACs) come down to one-day stays in medical/surgical acute-care hospitals. The interesting thing about this is that the denials occurred because the service provided was provided in the wrong setting. RACs collected $89 million of overpayments from the group of hospitals that reported this piece of data to the American Hospital Association (AHA) for its latest RACTrac Survey (November 21, 2011 report).

Jan

2012

CMS Updates its Electronic Submission of Medical Documentation

Written by Melanie Combs-Dyer, RN

Healthcare providers who receive documentation request letters from Medicare Review Contractors can now respond electronically. Until now, providers had only twp options: mail or fax. The Centers for Medicare & Medicaid Services (CMS) calls the new mechanism Electronic Submission of Medical Documentation, or esMD.

Feature Stories

Out-of-Network Reimbursement: Don’t Expect Insurers to Do the Right Thing

Thomas J. Force, Esq. | TUSEDAY, 17 January 2012

Former New York Attorney General and current Gov. Andrew Cuomo early in 2008 conducted an investigation into what he viewed as under-reimbursement of out-of-network claims by most insurers in the state. Cuomo investigated what he referred to as "industry-wide" usual, customary and reasonable (UCR) underpayments that affected consumers in...

Predictive Modeling: A Silver Lining in the Perfect Storm

Karen Mandelbaum, J.D. | TUSEDAY, 17 January 2012

As the provisions of the Patient Protection and Affordable Care Act begin to go into effect, the healthcare industry is headed toward what many consider to be the perfect healthcare storm. Providers, and physicians in particular, are facing uncertainty with respect to what they can expect in terms of reimbursement...

News Analysis

The Use of Observation in Patients Undergoing Outpatient Procedure

Steven J. Meyerson, M.D. | TUSEDAY, 17 January 2012

The outpatient observation generally is ordered when physicians require time to complete the evaluation of an ED patient to determine the need for admission - or to complete simple treatment that can be rendered within in 24 hours - but it also may be ordered following outpatient surgery when the...