Healthicity Blog

Coding audits are the heartbeat of any compliance program. That’s why staying on track with your audit is essential to your program's success.

There are a lot of Copy and Paste horror stories. Physicians who accidentally copy and pasted information from one patient’s record to a different patient. Or Copy and Pasting that goes rogue and suddenly, a woman with a family history of breast cancer has a history of breast cancer herself.

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

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.

An organization that fails to create and maintain an effective compliance program could be forced to return overpayments. And providers may face severe civil, criminal, and financial penalties.

Sometimes, when I mention coding and documenting Transitional Care Management, coders and auditors will get a crazy look in their eye that can best be described as, “subtle fear.”

But don’t panic, it’s easier than you think!

The Centers for Medicare and Medicaid Services (CMS) issued the Reform of Requirements or Long-Term Care Facilities in 2016 with a three-part phased implementation.

The DOJ just announced its biggest healthcare enforcement action in history. Compliance personnel will definitely want to know the details since over 100 physicians, nurses or other clinicians were individually indicted.