Clinical documentation is the cornerstone for all patient medical records. This information should be of the highest quality to allow for optimal patient outcomes as well as supporting research, medical coding and other uses of the medical record. Its purpose is to adequately relate the patient’s current and historical conditions and treatments with primary focus placed on situations that affect the current medical encounter. It also supports the provider’s defense should the case become a legal issue.
Review of 7 criteria that all entries in the medical record should include
Impact of documentation on coding & claims
Establishing a CDI team
The ICD-10 code set requires explicit documentation of conditions & treatments in order to support the severity of patients under treatment as well as allow for the significant specificity required by this code set. Ambiguous documentation and generic coding will no longer guarantee reimbursement and may generate a claims denial for lack of medical necessity. In this session, we will review the theory of high-quality clinical documentation which has the support of healthcare regulatory guidelines and peer-review research.
Additional consideration involves medical outcomes that may result in legal action. When clinical documentation is vague, missing key elements and conflicting statements, the provider may find that he/she is handicapped in supporting medical decisions and patient results, particularly when the result is a negative outcome for the patient.
In today’s healthcare environment, many patients have become educated consumers of medical services. They are more inclined to request their own medical record, carefully review explanation of benefits from payers, and request a review of any information they deem to be incomplete or questionable.
The session will provide an overview of the Anti-Kickback Statute (AKS) and review what it prohibits, as well as review the Statute’s available safe harbors. It will also show how violation of the AKS can raise FCA concerns, and it will provide an assessment of enforcement activities, showing how participants may be at risk. In addition, the session will review recent cases and show how they potentially impact participants.
We will provide an in-depth review of the AKS, focusing on what is prohibited under the Act and what the exceptions are. We will also review the case law, particularly the early case law that sets the stage and basis for how the courts interpret the law. Since one of the exceptions to enforcement under the Act is regulations promulgated by the Secretary, the “safe harbors,” payment practices that will not be subject to criminal prosecution and that will not provide a basis for civil monetary penalties or exclusion from the Medicare or Medicaid programs, we will examine these safe harbors, particularly those more frequently used, to show how protection from enforcement can be achieved. Specifically, we will review the investment, space and equipment rental, personal services/management contracts, and physician recruitment safe harbors.
In addition, we will discuss the OIG’s Joint Venture Advisory Opinion, where a hospital expands into a related service line by contracting with an existing provider of that service. The OIG has significant problems with such an arrangement. We will also discuss the recent advisory opinion by the OIG regarding Physician-Owned Entities. OIG views PODs as inherently suspect under the AKS because the opportunity for a referring physician to earn a profit, including through an investment in an entity for which he or she generates business, could constitute illegal remuneration under the AKS.
Finally, the webinar will review various cases to show how easy it is to run afoul of the Statute, and how the courts view compliance with it.
The AKS is currently the focus of law enforcement officials. The Statute provides that the offer or payment, as well as the solicitation or receipt, of “any remuneration” in exchange for referrals of any good, facility, service, or item for which payment may be made in whole or in part under Medicare/Medicaid is prohibited.
Recent cases and/or enforcement actions involving the AKS, violation of which has been held to be the basis of an action under the Federal False Claims Act, (“FCA”) raise serious concerns regarding compliance issues with hospital, physician practices and other healthcare entities. Recoveries under the FCA are at an all-time high, and the percentage of actions involving healthcare organizations has been increasing at exponential rates.
Venue: Recorded Webinar
Confused about HIPAA compliance requirements and how it applies to your organization? HIPAA can be complicated!! Knowing what an organization must have in place to meet regulatory requirements can be challenging. For anyone tasked with managing a HIPAA compliance program, understanding the HIPAA security and privacy management process is critical to implementing and maintaining a comprehensive compliance program. The webinar will look at specific challenges organizations face in meeting HIPAA compliance requirements. This will include risk management plans; risk assessments; and program management. A growing concern with healthcare data is cybersecurity threats. The webinar will review critical HIPAA related information security topics. After completing this webinar, a Covered Entity or Business Associate will have a clear understanding for how to meet the growing demands of HIPAA compliance. Webinar Objectives Definitions, Rules, CFR, & Acronyms Who Must Comply with HIPAA Requirements? What are the HIPAA Security and Privacy Rules? Challenges of HIPAA Compliance What is a HIPAA Risk Management Plan? Upcoming changes to the HIPAA Privacy Rule How to prevent HIPAA data breaches from occurring Q&A Webinar Highlights Learn from an expert on the implementation of the HIPAA rules Learn what the HIPAA management process requires Learn how to uncomplicate and be able to evaluate your organization’s HIPAA compliance program Who Should Attend Compliance Officer HIPAA Privacy Officer HIPAA Security Officer Medical/Dental Office Managers Practice Managers Information Systems Manager Chief Information Officer General Counsel/lawyer Practice Management Consultants Any Business Associates that access protected health information
ICD-10-CM updates for 2025 will become effective on October 1, 2024. These updates will include several guideline changes as well as multiple updates & additions to the specific chapters. This webinar will discuss the new guidelines as well as specific code categories in which you need to be alert to changes that may impact your code selection. All chapters will be included to ensure your specialty is covered. It is impoprtant that you be proactive and prepared when submitting your claims with discharge dates of October 1. Missed update information may cause a processing & reimbursement delay. Webinar’s Goals Be aware of guideline changes Learn about chapter specfic additions & updates Ensure you are prepared with new code information Align with your software vendors to implement any necessary changes Target Audience Revenue Cycle Managers & staff Billers Coders Clinical Documentation Staff Finance Managers Denial Management Staff Physicians Mid Level Providers Claims Follow Up Staff
One of the common functions in the medical revenue cycle for practices is adjudicating denials received from the insurance companies. Sometimes procedures or services are denied because they have been coded or billed incorrectly or in error, but it not uncommon that insurance companies will also deny claims in error. Whether the claim or the insurance company is in error contacting the insurance company in a timely manner is critical to ensure providers are reimbursed for services and procedures that were performed. Understanding the insurance companies’ rules and guidelines and knowing where to find them is also important when reviewing claim denials. Everyone in a revenue cycle department has good intentions of taking time to review denials received, and make corrections or write appeals when necessary, however, very often denials are put on the back burner for everything else that can come up in the office. This webinar will give proven tips on creating a process in handling denials by the types of the denials you maybe receiving efficiently. Session Highlights Reading denial and remark codes and understanding what they mean Know when billing a patient is the right thing to do Tips on processing denials in an efficient manner Applying insurance carrier policies to you claims to avoid denials References that can be used to defeat denials. Modifiers that can be used to avoid denials Documentation that is important to support your appeals The difference between a denial and remark code.
In addition to finalizing payment rates, the 2024 Final Rule includes promoting health equity, expanding access to behavioral health, improving transparency and promoting safe, effective and patient-centered care. The following areas will be covered in this webinar: Updates to OPPS & ASC Payment Rates Intensive Outpatient Program Scope of Benefits for Intensive Outpatient Program Physician Certification & Plan of Treatment Requirements Intensive Outpatient Program Payment Rates & Policies Opioid Treatment Program Settings Partial Hospitalization Program Changes to Community Mental Health Centers Conditions of Participation Remote Mental Health Services Payment for Dental Services Rural Emergency Hospitals Transitional Pass-Through Payment for Devices OPPS Payment for Dtrugs Acquired Through 340B Program Webinar’s Goals Provide clarity of Final Rule content and effects on your provision of services Advances Centers for Medicare & Medicaid Services’ commitment to strengthening Medicare Changes that will help address health inequities Use of lessons learned from COVID-19 PHE to inform approach to quality measures Target Audience Physicians Practice managers Medical assistants Nurses Compliance staff Billers Coders Revenue Cycle Risk Management Charge entry staff Finance Staff Therapists