Both government and private payers continue to aggressively monitor providers to prevent and recover overpayments. This is evidenced by the fact that the number of audits conducted in recent years has increased dramatically. A negative audit finding can result in the need to repay five- or seven-figure amounts. Types of Audits Private Payer Audits Private…
CDI programs can validate patient care, support accurate coding practices, evidence-based care for quality-reporting measures
ACR offers education and guidance to help physicians manage transition to ICD-10 and handle more federal audit initiatives next year
What you need to know to prepare for, or appeal, a Medicare audit
Test your knowledge of Medicare audits
If you are prepared for an audit, your medical practice will run more smoothly from both a financial and personnel standpoint.
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.
Due to federal regulations and the variety of audits that now exist, the ACR has developed an overview of guidelines and identified a list of resources to keep handy to ensure all current guidelines are strictly followed.
Practice management changes and opportunities in 2012
Government Exclusion Program : Can It Affect Your Practice?