Healthicity Blog

Most medical coders, auditors, and compliance professionals are aware of the Centers for Medicare and Medicaid Services (CMS) Targeted Probe and Educate (TPE) program. It is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help. 

November was a very busy time for the Department of Health and Human Services Office of Inspector General (OIG) Work Plan. Fifteen new items were added during the month. Below are some of the notable items added this last month.

The first major revision to the Evaluation and Management (E&M) coding and documentation guidelines in over two decades has put the spotlight the importance of Medical Decision Making (MDM) as the essential element when choosing an E&M level that isn’t time-based.

In past years at Thanksgiving time, we’ve written about the reasons compliance professionals should be thankful for working in the compliance profession. This year, let’s explore why organizations should be grateful for you, the compliance professionals, who build and manage compliance programs.

On our latest episode of Compliance Conversations, we’re taking an in-depth look at the revenue cycle and coding. We’re joined by Stephanie Perry, the outpatient medical supervisor for e4health, as she shares insights from her 12 years of experience in coding, auditing, training, and leadership...

Reporting incidents of potential fraud should be on every compliance professional’s radar (because it’s definitely on the OIG’s).

It is probably not intentional, but it sure seems like there is a theme to many of the U.S. Department of Health and Human Services Office of Inspector General (OIG) Work Plan items added in October 2023. 

Traditionally, as the calendar year approaches its end, many compliance programs evaluate their annual audit plan to assess its effectiveness and revise the plan as needed for the following year. Some compliance programs may do this at other times of the year. When it happens is not as essential as...