Tag Archives: compliance

Anthem OIG Audit Reveals Coding Issues

Last month, the Office of Inspector General published the report of a compliance audit conducted on one of Anthem Community Insurance Company, Inc.’s Medicare Advantage (MA) contracts. The OIG concluded that Anthem was overpaid by $3.4 million. MA plans’ payments … Read Full Post

Tagged Anthem, coding audit, compliance, OIG, overpayment |

Compliance Tool-kit Should Include External Validation

Although all providers should have a Compliance Program, it seems that mostly larger groups have them in place and even then, to varying degrees. Many practices have some form of internal validation of a coder’s work; most of the time, … Read Full Post

Tagged auditing, coding compliance, compliance, HCC, medicare risk adjustment, mra, validation |

Common and Avoidable Survey Issues – Independent Contractors

In this four-part series, so far, we’ve explored some of the most common and avoidable survey deficiencies: illegible signatures and missing titles, expired documents and missing supervision, and failure to follow the plan of care. Today we’ll cover certain aspects … Read Full Post

Tagged avoidable survey issues, common survey deficiencies, common survey issues, compliance, expired documents & missing supervision, failure to follow the plan of care, healthcare providers, home health agencies, illegible signatures and missing titles, independent contractors |

Common and Avoidable Survey Issues – Failure to follow the Plan of Care

We’ve established that regulators are pretty narrow-minded when it comes to interpretation of the rules. And they have to be. Subjectivity contaminates the process and things fall through the cracks. In this installment of our four-part series on Survey Issues, … Read Full Post

Tagged avoidable survey issues, common survey deficiencies, common survey issues, compliance, failure to follow the plan of care, healthcare providers, home health agencies, home health aide services, nursing visits, patient care, plan of care |

Common and Avoidable Survey Issues – Expired documents & missing supervision

Last time, we started our series on some of the common survey deficiencies with a discussion of signatures. This week, we’ll tackle another popular issue: the myriad documents in a personnel file. Bur first, a word about regulators…. They’re so … Read Full Post

Tagged avoidable survey issues, common survey deficiencies, common survey issues, compliance, documentation, expired documents & missing supervision, healthcare providers, home health agencies, qi process, supervisory visits, tracking the details |

Common and Avoidable Survey Issues – Illegible signatures and missing titles

Most of us who’ve been around healthcare know that physician handwriting is hieroglyphic, at best. However, nurses and other professionals aren’t far behind. Maybe it’s our keyboard-oriented world, but handwriting is getting worse every day. Keeping in mind that medical … Read Full Post

Tagged accreditation, avoidable survey issues, common survey issues, compliance, healthcare providers, home health agencies, illegible signatures and missing titles, master list of signatures, re-accreditation, survey deficiencies, tracking the details |

QI, PI, QA – Making Sense of Alphabet Soup (Part 3)

In the first two installments of this four-part series on QI, PI, QA – Making Sense of Alphabet Soup, we discussed the basics of QI and how to create a Quality Study. This blog takes you to the next step … Read Full Post

Tagged auditing, center for medicare and medicaid services, compliance, corrective action plan, home health agencies, qi committee, qi process, quality improvement, supervisory visits |