Expert Opinions / Auditing & Compliance

All Expert Opinions | Auditing & Compliance | COVID-19 | Revenue Integrity

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

Compliance and auditing offer an opportunity for continuous improvement. Done right they help organizations better serve patients, mitigate risk and exposure, and improve reimbursement and revenue. But what constitutes doing it right? Kathy Pride, Executive Vice President of Coding and Documentation at Panacea discusses the three most common mistakes in this article.

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Is Automation the Answer in Auditing?

Ask Kathy Pride, and she’ll tell you: there are two ways for healthcare providers to perform proactive auditing of their claims. There’s the old way – and there’s the better […]

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What’s on Your 2021 OIG Compliance Greatest Hits List?

Compliance plans are critical to making sure your organization is mitigating risk. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recommends that you audit […]

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New ICD-10 Codes Create Clarity in Capturing COVID in 2021

The chaos and confusion fomented throughout the American healthcare industry by the continuing COVID-19 pandemic has been bad enough in of itself – but when coders found themselves unable to […]

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Three Key Takeaways from the FY 2021 Inpatient Prospective Payment System Proposed Rule

Typically, we would have the Final Rule updates to the Inpatient Prospective Payment System (IPPS) for the 2021 fiscal year (FY) 60 days prior to its effective date. However, this year, citing the COVID-19 public health emergency (PHE), publication was delayed. The final rule was published on September 1, or 30 days before the effective date.

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Five Key Takeaways from the CY 2021 Outpatient Prospective Payment System Proposed Rule

On August 4, the Centers for Medicare & Medicaid Services (CMS) released the Changes to Hospital Outpatient Prospective Payment System (OPPS) for the 2021 calendar year (CY). The proposed regulations were published in the Federal Register on August 12, and comments are due by October 5.

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What Radiology Practices Need to Know About Medicare’s Prior-Authorization Requirements

Beginning July 1,2020  Medicare required prior authorization for five procedure classes: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, and vein ablation. As a reminder, prior authorization was announced through the Calendar Year 2020 Outpatient Prospective Payment System/Ambulatory Surgical Center Final Rule (CMS-1717-FC).

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Relaxing Rules for Telehealth

I’m sure everyone has heard the saying“the only constant is change.” Well, it certainly rings true these days. The Centers for Medicare & Medicaid Services (CMS) issued a second interim final rule on April 30, offering another round of coding and documentation updates related to telehealth during the public health emergency.

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CMS and AMA payment and coding updates, effective July, 1 2020

Panacea has summarized the Centers for Medicare and Medicaid Services (CMS) and American Medical Association (AMA) payment and coding updates, effective July 2020 (with some retroactive changes). Please review the updates for possible implementation in your hospital chargemaster and/or review by applicable department, coding and billing staff.

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E&M Changes: How Will They Affect Your Practice?

As many of you have heard, there are major changes coming to evaluation and management (E&M) codes in 2021. The changes were finalized in the 2020 Physician Final Rule.

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