From Report on Medicare Compliance - With recovery audit contractors (RACs) on light duty and Medicare administrative contractors (MACs) limited to probe-and-audit reviews under the two-midnight rule, Colleen Dailey, clinical coordinator of defense audits at WellSpan Health, is knee deep in claim denials from commercial payers. It’s a different world than Medicare, because the denials often stem from problems with preauthorizations for diagnostic tests, which are sometimes a matter of chasing down paperwork under the gun or fighting battles that can’t necessarily be won, she says. Read more
From Report on Patient Privacy - You can’t miss the headlines: “Coming in 2015: Even more health care data breaches,” “Health care to be ‘plagued’ by data breaches in 2015.” Several organizations have released reports pinpointing the threat health care faces from hackers and malware and predicting growth in breaches this year. Experian Data Breach Resolution, a well-respected company that has helped businesses plan for and mitigate consumer risk following data breach incidents for more than 10 years,… Read more
From Report on Medicare Compliance - To make the best use of resources and avoid driving employees crazy with seemingly duplicative audits, compliance and internal audit departments may want to coordinate audits. Although their end game may vary a bit, there is enough overlap to work together for the sake of efficiency, one expert says. “With the increase in government auditing initiatives, it becomes more and more important to be proactive in your compliance auditing and monitoring. Read more
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