Author

Elizabeth
Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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    To file claims for reimbursement to Medicare, you must be a recognized Medicare provider or supplier, meaning that you must first enroll in Medicare. CMS gives you two enrollment options: You can take the paper route and fill out and submit by mail the CMS-855   Read more..
    Posted on 30 Nov, 2018
    By Elizabeth
    Navigating Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS)
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    What Your Practice Must Know About the HIPAA Privacy & Security Rules HIPAA fails continue to populate news headlines. Fresenius Medical Care North America (FMCNA), for instance, didn’t implement HIPAA’s risk assessment and risk management requirements, which resulted in 5 HIPAA breaches. It took only a few   Read more..
    Posted on 26 Nov, 2018
    By Elizabeth
    Consider the Cost of HIPAA Noncompliance — Part 3
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    Meet the provisions of the HIPAA Privacy, Security, and Breach Notification Rules or prepare to pay the price. Ignorance of your legal obligations under HIPAA is not a justifiable excuse for failing to implement reasonable and appropriate safeguards. Covered entities have had sufficient time to establish effective   Read more..
    Posted on 6 Nov, 2018
    By Elizabeth
    Consider the Cost of HIPAA Noncompliance — Part 1
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    Backstory: Why NCCI was Started The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for the implementation of the National Correct Coding Initiative (NCCI), which was developed to encourage correct coding procedures on the national level and to reduce inappropriate coding that   Read more..
    Posted on 20 Jul, 2018
    By Elizabeth
    Nip Errors in the Bud with the NCCI and MUEs
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    The Office of Inspector General (OIG) plays an important role in negotiating, developing, and enforcing corporate integrity agreements (CIAs). As a condition of settlement in a variety of civil and false claim cases, OIG will require an organization to incorporate a CIA in exchange for   Read more..
    Posted on 17 Jul, 2018
    By Elizabeth
    Understanding the Ins and Outs of Corporate Integrity Agreements
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    What is a compliance plan? A compliance plan is a collection of steps that a provider, organization, or practice establishes to ensure adherence to federal and state regulations. OIG developed voluntary compliance program guidance in an effort to help organizations with their compliance programs. Resources   Read more..
    Posted on 13 Jul, 2018
    By Elizabeth
    How to Write an Effective and Powerful Compliance Plan
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    Medicine codes for both therapeutic and diagnostic services include injections, physical medicine, and rehabilitation services. These are some of the most difficult services to audit and, as a result, some of the most frequently audited in the medicine section of CPT®. Injections and infusions Injections and   Read more..
    Posted on 10 Jul, 2018
    By Elizabeth
    How to Overcome Challenges in Medicine Auditing
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    Doctors deal with interruptions every day. They need to call a patient back. The coding department asks them for clarification on a patient charge. Clinicians and staff come in to talk to them. Although the intention is there, the physician may not document the information   Read more..
    Posted on 3 Jul, 2018
    By Elizabeth
    Connect the Documentation Dots to Revenue Outcomes
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    National healthcare fraud is on the upswing, with a 400% increase in annual takedowns since 2013—and this, despite sequestration of mandatory funding for the Department of Justice (DOJ), the Department of Health & Human Services (HHS), the Office of Inspector General (OIG), and the FBI. Take   Read more..
    Posted on 29 Jun, 2018
    By Elizabeth
    400% Rise in Healthcare Fraud Takedowns
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    Coding is integral to claim submission. To prepare and submit a claim for reimbursement, you need documentation of all services and procedures performed and the reason, providing a diagnosis for each to demonstrate medical necessity. Medical practices use a superbill, also called an encounter form,   Read more..
    Posted on 27 Jun, 2018
    By Elizabeth
    Staking Your Claim