The hospital/health system revenue cycle has a significant role in hospital billing compliance. The billing department is the final gatekeeper for compliance, as it is the final area to touch a bill before it is sent to Medicare. Therefore, it is essential that billing staff understand key compliance risk areas.
To fully understand where your organization's risks lie, you not only need to have a firm grasp on risk analysis and assessment processes, you need to define these processes as well.
CMS' 2014 IPPS final rule redefined inpatient admissions when it implemented the 2-midnight rule, which requires a validated physician order, documentation of medical necessity, and the expectation of a stay crossing two or more midnights.
You hear it over and over again. Covered Entity (CE) A failed to produce an ongoing risk assessment for HIPAA security compliance. CE B had an incomplete risk analysis, leading to a failure to recognize security weaknesses and vulnerabilities. And in come the fines.
Better late than never. This is what some healthcare professionals are likely saying about the delayed release of the fiscal year (FY) 2014 OIG Work Plan, which was due to be released in fall 2013 but did not make an appearance until January 2014.
