Insights

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,...

Are you ready for the FY2017 ICD-10-CM/PCS Code Update?

The ICD-10 partial code freeze is over and effective October 1, 2016 there will be many changes to the ICD-10 code set. Recently both the Centers for Disease Control and Prevention (“CDC”) and Centers for Medicare & Medicaid Services (“CMS”) released the 2017 ICD-10-CM and ICD-10-PCS codes. Below is the...

The 60 Day Overpayment Rule

Reporting and Returning Self-Identified Overpayments: the 60 Day Overpayment Rule Overpayments occur, even in the most efficient and complaint provider settings. Overpayments may be isolated (e.g., adding a modifier to a claim) or involve hundreds of claims (e.g., inappropriately billing observational services). Overpayments may occur as a result of a...

Improve your CDI query process with mobile technology

Why use mobile technology to improve your CDI query process? DocEdge™ Communicator mobile and web-based application: Expedites physician responses securely Drives query quality Reduces notification fatigue See the infographic below for more information.  

Enterprise Risk Management – Essential Elements for a Successful Program

From our experience assessing and implementing Enterprise Risk Management (ERM) programs across the country, Provident has identified seven key elements for success: Phased Approach – ERM programs involve active engagement from leadership as well as on the ground operational teams. Enhance or develop your program in phases, allowing for organizational...

Clinical Documentation Improvement in 2016

Clinical Documentation Improvement in 2016 – The New Normal Over the past several years, Clinical Documentation Improvement (CDI) Programs have proliferated. In fact, 81% of hospitals have reported having a CDI Program according to a 2015 study by the Advisory Board. The emphasis on documentation has been driven by internal...

Stay compliant: High cost DRGs you need to pay attention to

It’s been eight months since the implementation of ICD-10. It appears the sky has not fallen. Coder productivity as expected has slowed, but is showing signs of improvement. In a recent AHIMA survey conducted in early May approximately 68% of the 156 coding professionals who responded reported that there was...

Reporting Structures of a Compliance Program

While implementing an effective compliance program is not a guarantee of fraud, waste and abuse prevention, it does help mitigate the risk of improper conduct. One key element of an effective and successful compliance program is oversight and defined reporting.  Below are tips to consider when implementing or evaluating the...

About Us

Leveraging our deep operational experience and real world understanding of the regulatory landscape, Provident partners with our clients to meet the diverse challenges of the evolving healthcare industry. With proven solutions, expertise, innovative thinking, and specialized tools and techniques the Provident team works collaboratively with clients to optimize their financial and operational performance.

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