Healthicity Blog

Few coding modifiers have drawn as much scrutiny as modifier -25. Used to indicate a significant, separately identifiable evaluation and management (E/M) service on the same day as another procedure, modifier -25 has long been a point of focus for third-party payors and government enforcement...

Physician group practices face mounting regulatory responsibilities, but many continue to overlook compliance blind spots that can carry major financial and reputational consequences.

For many healthcare practices, “incident-to” billing is a common strategy used to increase Medicare reimbursements.  It sounds like a smart revenue move. But without a clear understanding of the rules, it can also be a compliance landmine.

Every strong compliance program starts with the ability to identify and act on potential issues — but turning those reports into trackable, manageable actions can be where things start to fall apart.

It’s often said that “Individuals make decisions, not the organization.”

The healthcare compliance landscape is changing—and the C-Suite must be prepared. 

With physician and clinician shortages in healthcare, many entities are turning to non-physician practitioners (NPPs) such as nurse practitioners or physician assistants. Often, NPPs and physicians provide services to the same patient on the same day.

The last item on the OIGs list of 7 Elements of a Successful Compliance Program is focused on responding to detected offenses and developing corrective action initiatives.