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Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page 2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers Click here for more sample CPC practice exam questions and answers with full rationaleEX: 90832 TG Psychotherapy 30 minutes with patient and/or family member
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Five simple tips to help healthcare organizations prevent fraud
by Elizabeth Stepp, senior counsel at Oberheiden Law Group, in Dallas
It’s impossible to calculate the amount of healthcare fraud that exists, as much of it slips under the radar. However, healthcare fraud poses a serious problem, putting the health and welfare of beneficiaries at risk while costing taxpayers billions of dollars.
Preventing healthcare fraud and abuse is challenging, especially for hospitals, hospices, and other similar organizations. While there are a lot of honest and well-intentioned healthcare providers, there are quite a few perpetrators?ranging from street criminals to large companies. As such, owners of healthcare organizations need to be on their guard at all times. After all, allegations of fraud and abuse against low-level or top brass employees can affect the reputation of any healthcare organization.
But if you’re the owner of a small or large healthcare organization, don’t let this worry you. The following are some tips to help you prevent your organization’s reputation from taking a hit, and to avoid costly lawsuits.
Perform background checks before hiring
Pre-employment screening for employees, as well as contingent or temporary workers, is a common best practice for healthcare organizations. That being said, not all organizations have the time and resources to perform thorough background checks. Add to this a shortage of quality caregivers plus an increase in the number of patients, and employers find it easy to rely on trust instead of facts.
Since a single scam artist can taint your organization’s reputation, avoid employing or hiring individuals just because they appear to be trustworthy. Make sure pre-employment background checks include the following:
Additionally, check personal references, verify Social Security numbers, and have individuals undergo drug tests.
Have policies and procedures in place
Formalized policies and procedures promote regulatory compliance and workplace safety, and above all guarantee safe and quality patient care. Healthcare organizations also need to have policies and procedures in place to safeguard protected information. Start with defining access and authorization controls, and separate duties in order to reduce opportunities of fraud.
Make sure that policies and procedures are up-to-date and well written, so as to reduce practice variability. Practice that varies from one person to another can lead to sub-standard care and reliance on memory, which in turn can cause errors and oversights. Apart from this, organizations should have a defined set of internal controls to produce accurate financial reports, help comply with laws and regulations, oversee asset protection, and so on.
If you’re not sure about which policies to implement, getting in touch with a healthcare fraud defense attorney will be helpful. These lawyers can defend your case, and they know what it takes to prevent becoming a victim of fraud.
Perform audits regularly
Accurate and complete clinical documentation is important if you want to provide quality healthcare. The best way to improve documentation, and the care that your organization provides, is to conduct regular medical audits. Medical audits can also improve the financial health of your organization, and determine areas that need corrections and improvements.
Ensure that medical auditing and monitoring in your healthcare organizations is:
Protect data
For healthcare organizations, protecting data can mean reducing the number of emergent care cases, improving patient outcomes, providing better oversight and care, and increasing revenue. This makes it necessary for all healthcare organizations?big and small?to protect data. That being said, a lot of small- and mid-sized healthcare organizations think spending on data protection is pointless, as even organizations that take the appropriate steps are attacked by fraudsters.
Sure, data breaches keep happening. But, if you do what’s right, you can definitely protect your organization from being an easy target?and healthcare abusers like easy targets.
Here are some things to keep in mind:
Make it easy to report fraud
Reporting fraud and abuse?or any suspicious activity?should be an easy process. You’ll also have to set up a system so that vendors, employees, and patients and their family members can report abuse anonymously.
Most importantly, take required action on all complaints received. By addressing issues promptly, you’ll instill confidence among your employees and patients.
Protect your healthcare organization today
As an honest healthcare provider, you’d certainly want your healthcare organization to be free of fraud and abuse. Having the right intentions alone won’t be able to help you achieve your goals; you’ll have to take the necessary steps too.
With the information given here, you now know what you need to do to ensure that your healthcare organization is safe. Implement these tips right away, and say goodbye to fraud and abuse!
The Workgroup for Electronic Data Interchange (WEDI) released an issue brief providing additional information to organizations regarding several key points of confusion for healthcare providers and organizations. The brief primarily addresses Guideline 19 from the 2017 ICD-10-CM Coding Guidelines. WEDI also further clarifies ICD-10 flexibilities in the document. According to WEDI, Guideline 19 has caused […]
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