The Top 3 Compliance and Auditing Mistakes and How to Avoid Them

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In today’s environment of increasing regulatory oversight and ever-changing reimbursement policies, compliance must be more than a checkbox. Though an annual compliance and audit plan is not legally mandated, there are few healthcare organizations that don’t have compliance on their radars. However, if your compliance focus is simply to check a box, you’re missing out.

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CMS Price Transparency Requirement: Six Steps Towards Ensuring Compliance and Defensible & Rational Pricing

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The CMS 2019 transparency requirement underscores their ongoing initiative and emphasis on empowering patients through better access to hospital charge information.

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It’s a Fact: Revenue Integrity Programs Increase Net Revenue

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Is your revenue integrity program performing at full capacity?

Perhaps more important, do you have a revenue integrity program (or department) at all?

A survey conducted by the Healthcare Financial Management Association (HFMA) reports that less than half (44%) of providers contacted have a revenue integrity department to track accurate coding and charge capture, establish reasonable pricing for services, ensure legal and regulatory compliance, and develop effective financial reporting. Yet those that have established revenue integrity programs have realized an overall increase in net revenue.

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Does your organization have a strategic plan to address CMS FY19 IPPS proposed rule that requires hospitals “to make public their standard charges via the Internet?”

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Written By: Fred Stodolak, Executive Vice President, Mark Spehar, Senior Vice President, Financial Services, Henry Gutierrez, Vice President, Financial Services

There is an increasing debate surrounding CMS FY2019 IPPS proposed rule, published April 24, that would require hospitals “to make public a list of their standard charges via the internet.” Discussions around this topic have pointed out a number of valid arguments:

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Cultivating Homegrown Inpatient Auditors

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By training coders who already are on staff, hospitals leverage institutional knowledge and build career paths.

Changes in payment policies, laws, and regulatory oversight are forcing healthcare organizations to respond to increased regulatory scrutiny and audits. Medicare audits have increased by 936 percent in the past five years*. Ad hoc inpatient audits are no longer enough of a defensive strategy. Robust internal auditing programs are becoming a must for inpatient organizations.

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Key Learnings from HCCA 2018 Compliance Institute Conference.

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We had a great time at HCCA’s Compliance Institute conference in Las Vegas and enjoyed meeting everyone.  It’s always so exciting to see all of the strategies and methods professionals across the healthcare industry are using to accomplish their diverse goals.

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IR Coding: 100% Bundled, Component Coded or Hybrid-Bundled

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In 1992, CPT coding options for interventional radiology (IR) procedures underwent a seismic shift in “how” to code. Gone was the old method of complete procedure codes (a one-size-fits-all code); the new method added separate options to describe “what was done” and “where or how you did it.”

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The OIG Targets Herceptin Billing Errors

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Creating an Internal Inpatient Auditing Program

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Changes in reimbursement policies, laws, and regulatory oversight are forcing healthcare organizations to respond to increased regulatory scrutiny and audits. Medicare audits have increased 936 percent in the last five years alone, according to Becker’s Hospital CFO, and ad hoc inpatient audits are no longer enough of a defensive strategy.

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Panacea to Present Education Session on Pricing Transparency at HFMA 2019 Virtual Conference on Consumerism, Cost and Compliance

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St. Paul, MN – April 9, 2019 – Panacea, a leading provider of mid-revenue cycle management software, consulting and educational solutions, is proud to announce that Senior Vice President Mark Spehar and Executive Vice President Frederick Stodolak will present at the Healthcare Finance Management Association’s (HFMA) 2019 Virtual Conference on April 18, 2019 from 1:00-2:00 p.m. Central Time. Their session is titled “The Pricing Transparency Conundrum – Juggling Rational Price Development with Healthcare Consumerism Leading Practices.”

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