At the start of 2018, it’s time to take stock of billing compliance risks that may affect your organization in the new year and patch potential holes before they become a problem.
The National Association of Healthcare Revenue Integrity is currently seeking speakers to present at the 2018 Revenue Integrity Symposium, to be held October 16–17, 2018, in Litchfield Park, Arizona. Is that special person you or a colleague?
A recent OIG audit and report revealed that Medicare incorrectly paid approximately $1.7 million to Carolinas Medical Center in Charlotte, North Carolina, as a result of incorrect billing on the part of the medical center.
Hospital and health system revenue cycle vice presidents and directors will once again meet to —review these strategies and new ones at the 2018 HealthLeaders Media Revenue Cycle Exchange, March 21-23 at Ponte Vedra Beach, Florida. To learn if you qualify for the invitation-only event, please contact Exchange@healthleadersmedia.com.
In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA) added a requirement that will dramatically revise the Medicare Clinical Laboratory Fee Schedule (CLFS) effective January 1, 2018.
Physicians may be angry at the increased documentation, coding, and billing workflow and compliance activities they must perform to be successful in new reimbursement models. However, to avoid accustations of fraud and upcoding, they must develop their own OIG-recommended compliance plan and be open to rigorous feedback and advice.
Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
