Compliance Officers have a myriad of risks to address. At Provident, we believe the following challenges should be prioritized for 2017 and included in healthcare Compliance Officer’s Compliance Work Plan: Quality Payment Program and other alternative payment models – With the rollout of MACRA, alternative payment models and bundles, compliance...
Author Archives: proedge
The Importance of a Business Associate Agreement
Two recent settlements by the Health and Human Services (“HHS”) Office of Civil Rights (“OCR”) illustrate the importance of executing a business associate agreement (“BAA”). The first was on March 16, 2016 when OCR announced a $1.55 million settlement with a not-for-profit healthcare system in Minnesota for failing to enter...
MACRA HAS BEEN FINALIZED: What you need to know
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rule has been finalized. Since publishing the proposed rule, CMS has addressed thousands of comments, created an easy to follow ‘what is MACRA’ website and released a 24 page executive summary of the final rule. Whether you have been keeping...
ICD-10 DRG Driven Shifts: COPD with Asthma Exacerbation
Through our work conducting DRG audits, Provident has identified a number of new shifts due to the change from the ICD-9 to ICD-10 codeset. Many of these DRG shifts were due to changes in the Official Coding Guidelines, Indexing, and procedure coding. Below is an example of one of the...
New Hypertension Codes Released
October 2016 ICD-10 Code Update: New Hypertension Codes Released New hypertension codes for hypertensive urgency (I16.0), hypertensive emergency (I16.1), and hypertensive crisis, unspecified (I16.9) went into effect for discharges starting October 1st. According to Coding Clinic, “The American Academy of Pediatrics requested detailed codes to track patients who present with...
Healthcare Technology Solutions: What Doctors Want
A survey recently conducted by the AMA found that doctors are most interested in utilizing technology that helps to improve patient care and safety and enhance physician efficiency. Of the 1,300 physicians surveyed, a majority also indicated that new technology solutions must interface with the EMR and ensure data privacy...
The Yates Memo and Healthcare: What you need to know
The Yates Memo in Practice Recently, the Department of Justice (“DOJ”) announced two False Claim Act (“FCA”) settlements requiring a Board member and executive leadership to make considerable monetary payments to resolve their liability for their involvement in the illegal scheme. In the first case involving North American Health Care...
Lessons learned from an Independent Review Organization
Provident has served as an Independent Review Organization (“IRO”) for organizations fulfilling their Corporate Integrity Agreements (“CIAs”). Throughout our engagements, we have identified key findings and recommendations through our review of Arrangement Procedures, Arrangement Requirements and Focused Arrangements. Below are key items we think are necessary to ensuring your policies,...
Readmission Rates Fall
Recently, the Centers for Medicare and Medicaid Services (“CMS”) released data showing that all but one state has seen the Medicare 30-day readmission rates fall due to the Hospital Readmission Reduction Program (“the Program”). The readmission rate fell by more than 5% in 43 states and by more than 10%...
QIOs Resume Review of Short Stays Under the Two-Midnight Rule
The Centers for Medicare and Medicaid Services (“CMS”) announced that as of September 12th CMS lifted the temporary suspension of short stays review by Beneficiary and Family Centered Care Quality Improvement Organizations (“QIOs”). QIOs will resume the review of initial patient status of short stays in acute care inpatient hospitals,...