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...
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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,...
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...
ICD-10 flexibilities updated
CMS/AMA joint announcement and guidance regarding ICD-10 flexibilities updated Last year, the Centers for Medicare & Medicaid Services (“CMS”) and the American Medical Association made a joint announcement regarding guidance on ICD-10 flexibility. The ICD-10 flexibility allowed Medicare Part B providers to bill ICD-10 from the right family but not...
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.
2016 Coding Webinar Series
Announcing Provident’s 2016 Coding Webinar Series Provident is pleased to announce the 2016 Hospital Coding and Documentation Compliance webinar series. Provident’s Coding and Documentation Compliance Series will feature three (3) webinars focused on documentation standards, coding best practices and ways to ensure inpatient hospital based reimbursement aligns with the care...
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...