Nowadays, rarely does a week go by without the Department of Justice announcing another settlement related to allegations of a lack of medical necessity resulting in false claims....

Revenue Cycle Management (RCM) is the financial process utilized by healthcare providers to manage the administrative and clinical functions associated with claims processing,...

Recently, we posted about compliance risks associated with improper Evaluation and Management (E/M) Coding.

In the complex world of healthcare, compliance with federal, state and international regulations is not just a moral and ethical responsibility—it’s a financial one.  The cost of...

I always find it energizing to look back at the past year, and shift focus to what sits at the top of the risk list for the upcoming year. Here are some best practices and tips...

It’s finally here. The long-awaited, new OIG General Compliance Program Guidance (GCPG) has been released, all 91 pages of it. If you have not viewed it yet, click here: ...

I’ve had the privilege of leading and being part of compliance teams at non-profit providers, for profit payors, start-ups, and regulators. Regardless of the business model,...

When physicians or other clinicians submit claims for professional medical services, they select a medical code to represent the services. Procedures like a skin biopsy or an...

Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies like to “follow the money,” so to speak, and they often find it in...