Many practitioner audits fall short of best practices. The modern healthcare environment and complex goals for compliance require time, expertise, and attention to detail. Ideally, audits occur at regular intervals and identify incidents and patterns of potential billing and coding risk. There are also some surprising upsides of professional audits that include greater visibility of under-coding.
Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX presents this very timely and fascinating subject for us. A former nurse was charged, criminally prosecuted, and in March 2022, convicted of gross neglect of an impaired adult and negligent homicide for a 2017 fatal drug error. The purpose is to inform participants of a myriad of items so that facilities can evaluate and implement appropriate safeguards, train nurses and other staff, and take corrective actions before an adverse patient outcome occurs. What happened here is preventable and nurses should not flee the profession, especially because of the compassion shown by the judge.
1st Talk Compliance features guest Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “HIPAA and Beyond: Documentation Retention & Legal Holds.” This episode addresses laws that are relevant to healthcare industry participants, as well as compliance suggestions, and steps to take when either a legal hold or a preservation request arrives.
Catherine Short speaks with Rachel V. Rose, JD, MBA, principal with Rachel V. Rose – Attorney at Law, P.L.L.C., Houston, TX, on the topic of “The No Surprises Act – What You Need to Know.” Effective January 1, 2022, the No Surprises Act has implications for patients, providers, and insurance companies alike. The impetus behind the legislation, as well as the regulations, is to prevent patients from receiving bills for certain services that were performed or delivered by providers out of their plan’s network. The scope is limited and providers and plans alike need to take steps to understand the appeal process when a payment or claim is challenged. The purpose of this episode is to provide a brief overview of the evolution of the United States’ healthcare system and its relevance to the No Surprises Act. From there, the No Surprises Act and regulations will be explained, along with the appeal process. Finally, compliance tips will round out the show.
Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our esteemed presenter. 2022 was scheduled to be the the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay will occur it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
Catherine Short speaks with Melody Mulaik, President of Revenue Cycle Coding Strategies, a dynamic company that works with physician practices, healthcare systems, billing companies and other industry stakeholders to provide auditing, education and other collaborative consulting solutions to meet their coding and compliance needs. First Healthcare Compliance is a proud partner of Revenue Cycle Coding Strategies and our clients have enjoyed many webinars and previous podcasts by this team of experts. Melody joins us to address a current hot topic, “AUC – Delayed but not Gone.” 2022 was scheduled to be the official implementation date for AUC/CDS implementation but the 2022 Proposed Rule threw everyone a little curve ball. While a delay has occurred, it does not change the direction of the program or the need to prepare and test. As providers continue to either prepare their own practices or bridge the gap with imaging facilities, it is important that everyone be on the same page throughout the CMS implementation and remaining testing period.
One of the most crucial, yet complex, aspects of the healthcare sector is ensuring compliance. Every organization and individual offering healthcare or healthcare-related services needs to be aware of the regulations and laws and follow compliant practices. This is the only way to stay protected and achieve long-term success in the sector.
Sonal Patel, CPMA, CPC, CMC, ICD-10-CM, Healthcare Coder and Compliance Consultant at Nexsen Pruet, LLC, presented the webinar “Have No Fear: Auditing to Benefit Healthcare Entities, A Step Towards Proactive Compliance” recently. Sonal returned to answer many commonly asked questions from the webinar.
Melody W. Mulaik, MSHS, FAHRA, CRA, RCC, RCC-IR, CPC, CPC-H is the President of Revenue Cycle Coding Strategies LLC and our presenter. Every organization needs to ensure correct coding and billing practices to optimize appropriate reimbursement and adhere to payer and CMS guidelines. Whether the providers are responsible for coding or the organization employs coding professionals there are steps every organization should take to ensure correct processes. This session will break down the key areas of concern and provide realistic solutions to efficiently and effective validate current processes and identify areas of potential concern.
Stephen Bittinger Partner with K&L Gates in the firm’s Charleston office and a member of the health care/FDA practice group, will lead the presentation Year One of PHE Regulatory Disruption of Reimbursement: Who Adapted, Who is at Risk, Bad Actors at the Healthcare Compliance Symposium 2021 on April 22.