Organizations and CDI specialists must have a thorough understanding of how regulations and guidelines impact risk adjustment in the outpatient setting. A misinterpretation can easily lead to inadvertent upcoding—and that can lead to costly audits, settlements, and accusations of fraud.
High-risk opioid users are less likely to get a disproportionate quantity of opioid prescriptions from the emergency department than they are at an office visit, according to a recent study in Annals of Emergency Medicine.
HIPAA lays out specific requirements for breach response and reporting. Although most organizations might understand these requirements in theory, compliance is often tricky in practice.
Q: How does the Supplemental Medical Review Contractor determine which reviews to perform? Does SMRC work for CMS or our Medicare Administrative Contractor?
Fresenius Medical Care North American (FMCNA), a multistate clinic and provider network specializing in chronic kidney failure treatment, agreed to a $3.5 million HIPAA violation settlement.
