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Do You Have a “Direct Reporting Relationship” with Your Board?
Clues abound as to what the feds will consider an adequate relationship. ICD9 Codes Compliance officers, how often do you report to your board of directors? A) All the time; I love those guys. B) A few times…
Continue reading...Feds Tell Employers to Give Young Adults Coverage
7. June 2010
Health insurance organizations caught in the middle in suggestions by HHS and DOL. Self-insured employers should keep young adults up to age 26 on their parents’ health insurance plans before the September 23, 2010 deadline in the Affordable…
Continue reading...How to Get Physician Buy-In on Compliance Programs
24. May 2010
Straight from the horse’s mouth: A former physician turned CO tells all. Every compliance program needs provider buy-in, which can be tough to secure. Doctors are busy, but they have concerns that you can play into – patient care, quality…
Continue reading...United Settles with Physicians, Subscribers for $350M
24. May 2010
United agrees to record-breaking settlement covering flawed out-of-network claims for last 15 years. An important case that could change how health plans use databases to determine usual, customary and reasonable (UCR) rates has been settled, and more litigation is in…
Continue reading...Should Health Care Organizations Equate Risk with Compliance?
10. May 2010
Will your organization follow the trend of combining them? Compliance officers – and the health care organizations where they work – are often confused about how – or even whether – risk management and compliance should work together. “Risk management”…
Continue reading...Wisconsin Passes Parity Law for Mentally Ill and Drug Abusers
10. May 2010
Group health insurance plans undergo a revision as Mental Health Parity Act takes effect. Americans in Wisconsin are another step closer to total health care parity with a new state law that requires specific insurance coverage for individuals with nervous…
Continue reading...HHS Must Draft New Regs on Visitation, Advance Directives at Hospitals
26. April 2010
Hospitals that receive federal dollars must report on treatment of LGBT patients, create new policies to allow designated visitors. Just in time for National Health Care Decisions Day — a national campaign that aims to encourage people to complete…
Continue reading...New York OMIG’s Game Plan: Follow the 1’s and 0’s
26. April 2010
Even if you’re not located in New York, get ready for increased attention to areas in which compliance can be measured with a yes/no answer. The New York State’s Medicaid Inspector General likes to use binary measures – on/off, yes/no,…
Continue reading...New Health Care Reform Law Alters Stark “In-Office” Exception
8. April 2010
The new health care reform laws are on the books, and physicians should be aware that some of the exceptions to the Stark law have changed. One change concerns how to qualify for the “in-office exception,” which is addressed by…
Continue reading...Get Ready for More Modifier 59 Scrutiny
5. April 2010
Modifier 59 misuse led to millions in overpayments. When the OIG talks, not everyone listens, a new report indicates. The OIG makes hundreds of recommendations each year, advising practices and carriers to tighten up documentation, correct their modifier use, or…
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7. June 2010
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