Four weeks ago, a 65-year-old female visited Dr. Brown for a follow-up visit for her rheumatoid arthritis. While there, she also complained of diarrhea and stomach cramps from the new medication that she was prescribed. The rheumatologist made a decision to discontinue the medication and switched the patient to a new drug.
The operations management team in healthcare practices is expected to have an effective coding compliance program in place that is continually evaluated and reevaluated. To accurately assess the program’s effectiveness, several outcome indicators must be measured, including error rates in the provider’s documentation and the electronic health record (EHR). Due to increased scrutiny by the…
Compliance programs are an effort by the government to maintain integrity in the healthcare system. These programs target activities causing improper payment to determine their root cause: Was it a mistake or error, was it inefficiency or waste of resources, is the provider bending the rules or abusing the system, or was it intentional deception or fraud? There are also laws dictating the compliance culture within practices and institutions; for example, red-flag rules, antikickback statute, and stark law, to name a few.
Digitized patient records have transformed how clinicians record, understand clinical information
Know what’s included in the federal False Claims Act, Anti-Kickback Statute and other regulations and guidelines to prevent Medicare abuse