By Dhara Satija, HFMA MA-RI Chapter Board Member & Compliance Committee Co-Chair and Amber Fecik, NEHIA Board Member The HFMA MA-RI Chapter and New England Healthcare Internal Auditors (NEHIA) organization would like to thank all of those who made last week’s virtual Compliance and Internal Audit Conference a success! Thank you to our more than 140 participants who… Read More »
By: Katherine Record, Executive Director, Beth Israel Lahey Health Medicaid ACOs and Performance Network Compliance & Privacy Strategy, HFMA MA-RI Chapter, Compliance Committee Member, CMS is making changes to E/M codes 99201-99205 and 99211-99215, which are likely to be adopted universally across all payers (including commercial). What do you need to know? For the first time, physical exam… Read More »
By: Garrett Gillespie, Corporate Compliance Officer and Deputy GC, BMC HealthNet Plan; HFMA MA-RI Chapter Compliance Committee Member, What to review to identify risks: senior management surveys, operational management interviews, regulatory publications (e.g., OIG website), audit staff input, external sources. Audits are won or lost in the preparation. Think about: What do you need to know? What should… Read More »
As a refresher, under the Post-Acute Transfer Rule (PACT), if a patient was discharged below the Geometric Mean Length of Stay (GMLOS) and the discharge status on the claim indicated a transfer to post-acute care, then the hospital is entitled to a per diem payment amount and not the total amount a full DRG payment would provide. There… Read More »
Recently, the Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued its 2019 “Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs: Top Unimplemented Recommendations.” The OIG releases a version of this report each year outlining its top 25 unimplemented recommendations to reduce fraud, waste, and abuse (“FWA”) among HHS programs. This blog post… Read More »
Following a number of drug pricing reforms implemented or proposed in 2018, 2019 likely will bring more action from HHS and Congress to reduce drug prices. Key Points: In 2018, the Administration implemented and proposed several policy changes to reduce drug prices or spending, and Congress passed new legislation prohibiting health plans from preventing pharmacies from informing plan… Read More »
* * * * * This post sponsored by PwC. * * * * * The US health industry is showing signs of modernizing along the lines of tech, retail and hospitality, changes that should benefit consumers and the healthcare system overall. Once thought to operate outside the greater US economy, the industry—with its byzantine payment system, complicated… Read More »
In the current, ever-changing regulatory environment, smaller compliance teams face unique changes. The OIG’s supplemental Compliance Program Guidance[1] published in 2005 states that ‘there is no single “best” hospital compliance program. Some hospital entities are small and may have limited resources to devote to compliance measures; others are affiliated with well-established, large, multi-facility organizations with a widely dispersed… Read More »
The Trump Administration is moving full speed ahead with its proposals under the Blueprint to Lower Drug Prices (the “Blueprint”). Earlier this week, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule that would require pharmaceutical manufacturers to disclose the list price of their pharmaceutical products in direct-to-consumer (“DTC”) television ads (the “Proposed Rule”). This comes only a week… Read More »
Do you need a refresher in healthcare finance? Have you recently transitioned roles and could use an overview of the healthcare landscape? Do you have a new member of your team who would benefit from additional training? Join HFMA at the New to Healthcare seminar on Friday, September 21, 2018. The course will take place at Suffolk Law… Read More »
