Request for Information On April 14, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2018 Inpatient Prospective Payment System (“IPPS”) proposed rule including a Request for Information (“RFI”). The overarching message from CMS is to seek comments to the proposed rule and through the RFI that will...
Author Archives: proedge
Guidance on How It Determines the Effectiveness of a Compliance Program
The Department of Justice Issues Guidance on How It Determines the Effectiveness of a Compliance Program Recently, the Department of Justice’s (“DOJ”) Fraud Section released guidance entitled “Evaluation of Corporate Compliance Programs,” (“Compliance Memorandum”), which highlights how federal prosecutors investigate the adequacy of an organization’s compliance program during a criminal investigation....
What Is Your Organization Doing to Prevent MACRA-Related Penalties?
If you are one of the many healthcare providers/organizations baffled by the intricacies of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and have not taken action – you still have time. It is imperative that you participate at some level in 2017 to avoid potential penalties of...
Coding and Documentation Compliance Series
Provident’s Coding and Documentation Compliance Series featured three (3) webinars focused on documentation standards, coding best practices and ways to ensure inpatient hospital based reimbursement aligns with the care being provided. The third webinar in the series, ICD-10 DRG Audit Target Areas includes the following case studies: o Sepsis o...
2017 ICD-10 DRG Audit Target Areas: Sepsis
Provident has been engaged in ongoing DRG audits since the implementation of ICD-10 in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting target area case summaries with suggested audit strategies...
The Latest OCR Enforcement Actions
In the last few months, the Department of Health and Human Services Office of Civil Rights (“OCR”) announced several enforcement actions based on alleged violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Below is a summary of the recent enforcement actions: Untimely Reporting of a Breach....
Pulse of the Profession 2017 Report: Project Management Highlights
Good News for Healthcare: Project Success is Trending Up The Project Management Institute (“PMI”) recently released its Pulse of the Profession 2017 report. Each year, PMI conducts a global survey of project management professionals and highlights trends within the project management profession in its annual report. The healthcare industry is estimated...
Discharge Planning – Preparing for the IMPACT Act Proposed Changes
In the Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), the Centers for Medicare & Medicaid Services (“CMS”) propose to revise discharge planning requirements under the Medicare Conditions of Participation. The objectives of the revisions include improving patient quality of care and outcomes, reducing factors that lead to preventable...
2017 ICD-10 DRG Audit Target Areas
Excisional Debridement Provident has been engaged in ongoing DRG audits since ICD-10 was implemented in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting cases regularly in our newsletter. Please see...
OBTAINING VISIBILITY INTO OUTPATIENT RISKS AND OPPORTUNITY
The expansion of outpatient services continues to be a high priority for hospitals across the country. What continues to drive this transition? Value-based reimbursement models and patient demand. The proof is in the numbers – in 2013 there was an average of 2,145 outpatient visits per 1,000 people up from...