CMS grants Vistogard® New Technology Add-on Payment Effective October 1, 2016 The CMS decision means that Medicare will pay up to 50% reimbursement of the cost of Vistogard® in the hospital setting (up to $37,500), and it is expected to stay in place for two years until the cost of...
Author Archives: proedge
CDI Query Strategies Webinar
CDI Query Strategies: Webinar #2 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 second webinar in the series, Clinical Documentation Improvement (CDI) Query Strategies covered the...
Are you monitoring the right data? What HIM directors should be looking for.
The Health Information Management (“HIM”) department is the informational and financial hub of healthcare facilities. Coders, clinical documentation specialists (“CDS”) and quality/compliance analysts are the last line in an important workflow that determines a facility’s reimbursement. An HIM directors’ responsibilities go beyond making sure things just run smoothly. A successful...
Mobile Healthcare IT Adoption: Securing Physician Engagement
Mobile Healthcare IT Adoption: Strategies to Secure Physician Engagement According to the 2016 Red Hat survey, investment in mobile applications by healthcare organizations are paying off, with 78% of organizations surveyed reporting a positive return on their investment. With these positive returns, adoption of mobile healthcare applications is only expected...
The Impact of Escobar on FCA Healthcare Cases
Recently, the Supreme Court (“the Court”) considered whether whistle-blowers and the government should be allowed to bring False Claims Act (“FCA”, “the Act”) cases under the implied false certification theory. In a unanimous decision in Universal Health Services, Inc. v. United States ex rel. Escobar et al. (“Escobar”) issued on...
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, 2016 Coding Clinics & FY 2017 IPPS Final Rule: Key Changes covered the...
Elements of a HIPAA Business Associate Agreement
Business Associate Agreements: Required Elements The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Public Law 104-191, requires covered entities (“CEs”) and business associates (BAs) to execute a business associate agreement (“BAA”) with their business associates (subcontractors) to ensure that the BA agrees to comply with the Privacy and...
Top 7 Changes Coders and Physicians Need to Know About
FY 2017 IPPS and 2016 Coding Clinic – Top 7 Changes Coders and Physicians Need to Know About The 4th Quarter 2016 Coding Clinic and 2017 Inpatient Prospective Payment System (IPPS) final rule includes the most significant changes since the partial code freeze began on October 1st 2012. Below is...
RANSOMWARE: REAL THREATS, STEEP FINES
The healthcare industry has been no stranger to cyber and ransomware attacks. With increased threats and an uptick in Office for Civil Rights (OCR) enforcement as a result of those threats, organizations of all sizes should 1) evaluate their susceptibility to attacks, 2) employ processes and software to prevent attacks...
The 2017 OIG Work Plan: What You Need to Know
The Health and Human Services (“HHS”) Office of Inspector General (“OIG) released the 2017 Work Plan (“Work Plan”) outlining its priorities for new and ongoing audits and evaluations for the current and coming year. The OIG Work Plan also provides an update on items that have been completed, postponed or...