Self-Audits
Self-audits are critical. They demonstrate compliance, or at least a "good-faith effort" to be compliant; they minimize refunds of overpayments to "actuals" and also mitigate the potential for a multiple being added.
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Timely Claims Payment/Prompt Pay
I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law.
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2022 Annual Audit Elements: What Should Be Reviewed
Four months into 2022 and the question is: How far along is your audit of high, medium, and low-risk services? If you are like most practices or health systems, something always gets in the way and causes audits to take a back seat.
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HHS/OIG Exclusion List Violations
An important subject that should not be far from your mind is the OIG exclusions list. The HHS/OIG is not backing down on Employment of Excluded Individuals....
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TPE Audit Program Resumption
On Thursday August 12, CMS put providers on notice that the TPE audit program was kicking off again after more than a year hiatus due to the public health emergency (PHE)! As you can imagine, there is some chatter about when and what to expect once t...
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The Year of the Audit: Stand Your Ground with Payers
Over the years I have worked with so many wonderful and talented auditors and professionals at Blue Cross Blue Shield payers, UHC, Aetna, CIGNA, Humana, Medicare carriers, etc.
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DON'T FALL FOR IT - 2021 E/M - Guidelines are a Trap
At first glance, the changes to E/M documentation guidelines for office services coming in 2021 seem like a substantial reduction in the documentation burden for providers working in the office and make it much easier to document higher level service...
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The Truth about ZPICs - Why Oversight is Needed
ZPIC (Zone Program Integrity Contractors) letters' are the ultimate stop and gulp in healthcare since they are typically focused on potential fraudulent matters. ...
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