November 10, 2023 | By Toni Elhoms, CCS, CPC, CPMA, CRC On countless occasions, I have heard physicians and healthcare providers balk at the notion of learning how to level their E/M services based on medical-decision-making (MDM), and some will even go as far as to say things like “I don’t have time…
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Law vs. Health Law Fundamentals Written by: Rachel V. Rose, JD, MBA When was the last time you thought about what the “law” actually is and how it differs from what is commonly known as “health law”? Black’s Law Dictionary (2nd Ed.) provides two definitions: That which is laid down, ordained, or established. A rule…
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The Auditor’s Role in Appeals: A Key Player in the Compliance Process Written by: Betty Hovey, BSHAM CCS-P CDIP CPC COC CPMA CPCD CPB CPCI The appeals process is a critical component of health care compliance, ensuring that denied claims are appropriately challenged and reconsidered. When providers and health care organizations receive claim denials, they…
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The False Claims Act: 162 Years Later. Written by: Rachel V. Rose, JD, MBA Understanding the False Claims Act (FCA) Also known as the “Lincoln Law” – the False Claims Act, 31 U.S.C. §§ 3729-3733 (FCA) has been around since 1863 and its primary purpose remains the same – to root out fraud and return wrongfully…
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Getting It Right: The Anatomy of a Thorough Compliance Investigation Written by: Jordan Johnson, MSHA, iMPaCT Conducting a compliance investigation is a vital component of any organization’s effort to uphold legal, regulatory, and internal policy standards. Whether triggered by a whistleblower complaint, routine monitoring, or audit findings, these investigations must be handled with precision, neutrality,…
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Annual Compliance Training Requirements Written by: J. Paul Spencer, CPC, COC As a healthcare compliance professional, there have been two constant pieces of advice that I have provided for medical practices: If you do not have a compliance program, implement one, and Once you implement a compliance program, follow it. The Office of Inspector General…
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