Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant

Published: Tue, 09/27/16

Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant

The goal was to avert fraud, waste, and abuse. We all support that – we collectively pay for Medicare, and who likes throwing their money away? Let’s review the ideal: the patient receives excellent medical care, the provider does...

 
Is Cyber-Security Insurance Right for Your Practice?

2015 was a notorious year for cyber attacks in the healthcare industry, with more than 100 million health care records compromised in a single year. So far 2016 looks like it might be as bad or worse, once the Department of Health and Human Services' (HHS) Office of Civil Rights (OCR) gets all the breaches posted.

 
Downgrading DRGs: A New York Epidemic Out of Control

Do you find that your facility’s DRGs are being downgraded by third-party payers that are re-diagnosing patients? Are they also discounting the coding of suspected and possible diagnoses? You’re probably not alone. Sonya Manuel, a senior health information management (HIM) consultant and DRG coordinator for Jzanus Consulting in New York, tells RACmonitor that the battle with third-party auditors has been going on for years.

 
Guideline Changes: Taking a Step Backward?

The recent buzz surrounding changes to the ICD-10-CM guidelines have many wondering why we appear to be taking a step backward from quality instead of elevating standards with language indicating that physicians don’t need to document to meet clinical indicators or support conditions with their documentation.

 
The End of Relaxed ICD-10 Rules: What it Means for Private Practices

Physician practices have had nearly a year to acclimate themselves to the ICD-10 coding that took effect in October 2015. Thanks to a grace period known as ICD-10 “relaxed rules,” which were established jointly by the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA), the use of ICD-10 codes that did not meet the highest level of specificity requirements was allowed to continue without the risk of punitive action.