Healthicity Blog

1. CMS and Its Claims Processing Contractors Issued Conflicting Guidance on the Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims - “Medicare Part B paid for some immunosuppressive drugs billed with the KX modifier that were not eligible for Part B payment.

When a lot of healthcare organizations consider their risk under the False Claims Act, they often think of coding and billing errors submitted on 1500s or UBs. It’s probably the first place I’d consider looking as well for the greatest risk to a Medicare or Medicaid healthcare provider.

The field of compliance isn’t as simple as hiring honest people who will hopefully “always obey the rules.” In fact, careful hiring doesn’t constitute a compliance plan at all.

1. Under ‘Observation,’ Some Hospital Patients Face Big Bills - “In April, Nancy Niemi entered Vidant Medical Center in Greenville, N.C., with cardiac problems. She stayed four nights, at one point receiving a coronary stent.

As reimbursements shift from fee-for-service to value-based payments, the need for better risk adjustment audit tools are on the rise.

If you have a compliance program, you most likely have a full-time compliance officer or an individual who is accountable for your organization’s compliance program, even if it’s only a portion of that person’s overall duties.

Recently, compliance failures cost Florida physicians over $4 million dollars and resulted in a multi-million dollar settlement for a Tennessee hospital. The message is clear: compliance is no joke.

1. Surgery center says 34,000 patient records potentially breached - “St. Mark’s Surgery Center was hit by a ransomware attack that may have impacted the personal health information of 33,877 patients.