GAO Yellow Book Standards and Independent Review Organizations
The heightened focus on health care fraud, waste, and abuse at both the Federal and State levels in recent years…
An Update on the RACs Activities DRG Validation
This article highlights vulnerable areas that hospitals should take into consideration, along with specific tips for identifying problematic MS-DRGs.
Questions Raised About Necessity, Utility of Debarment Screening
Many providers are raising questions and concerns relating to the problems of sanction screening against the General Services Administration’s Excluded…
Medicaid Integrity Contractor Reform: MAC, MIC, ZPIC,RAC
Providers should examine workflow and procedures. They should have an appeal team organized, plan internal routing, and educate their employees…
How Can CEOs and Board Members Keep Score on Compliance Risks?
The U.S. Sentencing Commission and the Office of Inspector General (OIG) gave health care institutions a clear guide to effective…
Clarifying Sanction Screening: OIG LEIE Versus GSA EPLS
For over a decade, the OIG has been issuing “voluntary” compliance program guidance for the various health care sectors. In…
Recapping the RACs for the Upcoming Year
This article summarizes the RAC program, reviews the RACs activities in 2009, and provides guidance for dealing with the RACs…
Compliance and Program Integrity Under Health Care Reform
This article discusses the key factors to consider for compliance programs as a result of health care reform. About the…
Outsourcing Compliance in Light of Health Care Reform
To the extent that a provider or supplier does not have the necessary internal resources, getting compliance outsourcing assistance may be an appropriate…
Managing Risks When Implementing the New EHR Disclosure Accounting Requirements of ARRA
The American Recovery and Reinvestment Act of 2009 (ARRA) was signed into law on February 17, 2009, a critical measure to stimulate…
Surgical Never Events Billing Related and Non-related Services
Surgical “Never Events” Billing Related and Non-related Services As a follow-up to last month’s Current Developments’ article titled “Reporting E-codes for Surgical…
Protect Yourself: Know How to Bill Medicare for H1N1 and Seasonal Flu Vaccines to Prevent Revenue Loss
According to the Centers for Disease Control and Prevention (CDC), there have been 22,364 laboratory confirmed hospitalizations and 877 laboratory‐confirmed deaths…