Top 10 Compliance Pitfalls When Completing the CMS-1500 Form (And How to Avoid Them) Written by: Beth Schleeper The CMS-1500 form is one of the most widely used claim forms in healthcare for submitting insurance claims for professional services. While it is a vital tool for reimbursement, there are several compliance pitfalls that healthcare providers…
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…
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,…
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…
Understanding Internal Self-Referrals Written by: Ashley Morgan, Partner, Liles Parker PLLC Healthcare regulations outline legal risks related to internal self-referrals, making it important for both physicians and healthcare organizations to be informed about these issues. While internal referrals may seem like a natural part of integrated healthcare systems, they are heavily regulated under federal and…