Compliance

Harm Standard: Gone But Not Forgotten? New Factors Mimic Current Breach RegsHarm Standard: Gone But Not Forgotten? New Factors Mimic Current Breach Regs

From Report on Patient Privacy - Although covered entities (CEs) have been required since 2009 to notify affected individuals and the government, when appropriate, of breaches of unsecured protected health information (PHI), the so-called “harm” standard that triggers notice no longer exists under the new final regulations. Or does it? Are CEs really starting over when it comes to assessing whether an incident is a reportable breach under the final regulations issued on Jan. 25, which have a compliance deadline of Sept. 23? Read more

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Compliance Officer Role Evolves With Increase in External Audits (with Table: Reporting High-Level RAC Findings to Leadership)Compliance Officer Role Evolves With Increase in External Audits (with Table: Reporting High-Level RAC Findings to Leadership)

From Report on Medicare Compliance - With the explosion of external audits in recent years, the role of compliance officer is changing considerably. “Five or 10 years ago, third-party audits, especially from government agencies, were few and far between. They got handled, directed and completed by compliance officers,” Stephen Gillis, director of billing compliance for Massachusetts General Hospital and Massachusetts General Hospital Physicians Organization in Boston, said April 22 at the Health Care Compliance Association’s annual Compliance… Read more

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Compliance Blog

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Will Money Motivate More Fraud Tipsters?
By Francie Fernald - April 26, 2013
The Center for Medicare and Medicaid Services is taking a cue from the generous whistleblower rewards that have prompted the rapid growth of False Claims Act cases alleging health care fraud and an Internal Revenue Service program designed to motivate individuals to report tax fraud, which has...
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CMS Encourages Use of esMD in RAC Prepayment Therapy Reviews and Elsewhere
By Nina Youngstrom - April 16, 2013
Outpatient physical, speech and occupational therapy providers that face recovery audit contractor (RAC) prepayment reviews can use the CMS Electronic Submission of Medical Documentation (esMD) program to get information on the status of the claims review, CMS says. Therapy providers also can...
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The Part A/Part B Rebilling Dilemma: Withdraw Appeals or Wait It Out
By Francie Fernald - April 5, 2013
Since the Centers for Medicare and Medicaid Services announced its major policy shift on payment for outpatient services after inpatient services are denied as medically unnecessary, hospitals have been regrouping and strategizing on how to take advantage of the policy shift. As of March 13, the...
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