Prevention of Patient Complaints and Payer Denials: Covered vs Non-Covered Preventive Services Written by: Pam Vanderbilt “I just got a bill for my free annual visit!! Sound familiar? Calls from patients who are upset because they got a bill for services they thought were covered. When I research these complaints, the issue causing the services…
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…
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…
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…
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,…