Compliance

Compliance

HIPAA

Consult This HIPAA Checklist Every Quarter to Stay Compliant

When the HIPAA privacy laws first went into effect, medical practices were vigilant—but that hasn’t necessarily been the case recently. Some practices have relaxed their HIPAA compliance, and that’s a mistake. The government is still coming after violators, and has imposed more than $133 million in HIPAA settlements and penalties as of Sept. 30, 2022. […]
Advance care planning

Avoid These Advance Care Planning Errors to Keep Pay Flowing

Is your practice reporting advance care planning (ACP) properly? If you’re like the majority of practices that the OIG recently audited, you’re probably documenting these incorrectly, which could mean you’ll need to pay money back to Medicare. Here’s why: A recent OIG audit revealed that out of 691 ACP services they reviewed, 466 didn’t comply […]
Summary plan description

Steer Clear of ERISA Violations With a Summary Plan Description

The Employee Retirement Income Security Act (ERISA) governs how your practice must communicate to your employees about such topics as your health insurance plan and your retirement benefits. If your practice doesn’t abide by the law, you could face massive civil and criminal penalties, so it’s essential to stay on top of the requirements. One […]
recovery audit contractors

Avoid Paybacks to RAC Auditors by Following 7 Essential Tips

One audit type that’s always looming over medical practices involves Recovery Audit Contractors (RACs). These organizations are appointed by each MAC to uncover, confirm, and take back reimbursements Medicare made in error. Because they get paid a percentage of what they recover from medical practices, RACs are sometimes referred to as Medicare’s “bounty hunters.” Recovery […]
risk adjustment

Risk Adjustment: Are You Self-Auditing ICD-10-CM Codes?

Medical practices can get paid more for Medical Advantage claims by accurately reporting patient risk—but the main way insurers evaluate risk is through your diagnosis codes. And if your practice isn’t performing ICD-10-CM self-audits, you could be underrepresenting your risk and shorting your practice significant income without even knowing it. Background: Risk adjustment is a […]
Access to medical records

5 Steps Prep You for Oct. 6 Information Blocking Rule Deadline

Medical practices have had a few years to comply with the HIPAA privacy and security rules, which means you’ve gotten a handle on issues like giving patients access to medical records in a timely manner and keeping their private information secure. But one area that you may not have mastered yet involves the Information Blocking […]
DME and Stark Law

5 Ways Medical Practices Can Spot Risky DME Arrangements

As many medical practices are aware, Durable Medical Equipment (DME) fraud is running rampant, and you could be pulled into a case even if you didn’t knowingly violate the Stark law or Anti-Kickback Statute. Why? Because a DME supplier who violates these laws could present your provider’s DME prescriptions as evidence to shift liability away from […]
Healthcare audit

Key Strategies Help You Avoid a Medicaid Audit

As part of the Centers for Medicare & Medicaid Services (CMS), Medicaid auditors are eager to come after potential instances of fraud or abuse that could cost you a fortune in fines, penalties and exclusions if you aren’t careful. Check out several areas that Medicaid auditors are targeting, and find out how you can stay […]
HIPAA risk analysis

Create a Solid Telehealth HIPAA Risk Analysis Checklist

Your practice has created a Notice of Privacy Practices, overhauled your policies, and ensured that you don’t have any privacy breaches. But if you haven’t yet performed a HIPAA risk analysis, you’re falling short of the security rules. And with telehealth in such wide use, now is the time to make sure your patient information […]
fees for copies of medical records

Accurately Calculate Patient Record Copying Fees to Avoid Fines

Every practice manager knows how important it is to provide patients with access to their medical records as required by the HIPAA laws. But what you may be less clear about is how to calculate fees for copies of medical records — and if you ask patients to pay too much, you could be hit […]