Medical Billing Blog: Section - Audit
Archive of all Articles in the Audit Section
This is the archive containing links to all articles written in the Audit section of our blog.
Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.
Measures to Detect and Prevent Fraudulent Billing Practices
Fraudulent billing practices pose a significant challenge across various sectors, particularly in healthcare, insurance, and finance. These practices not only lead to substantial financial losses but also undermine the integrity of services and trust in these industries. Effective fraud and abuse prevention measures are essential to safeguard resources, maintain transparency, and ensure fair practices. This article delves into the key strategies and measures that can be employed to detect and prevent fraudulent billing practices. Understanding Fraudulent Billing Practices Fraudulent billing refers to the act of deliberately falsifying billing information to receive unearned benefits or payments. Common fraudulent billing practices include: Upcoding: Billing for a more expensive service than what was …
Data Analytics and Predictive Modeling in Healthcare Revenue Cycle Optimization
In the intricate ecosystem of healthcare, revenue cycle management (RCM) plays a pivotal role in ensuring the financial stability and operational efficiency of medical practices. As healthcare continues to evolve, integrating more technology and data-driven decision-making processes, the necessity for sophisticated tools such as data analytics and predictive modeling becomes increasingly apparent. These tools not only streamline billing and administrative tasks but also enhance the accuracy of financial forecasting, risk management, and resource allocation. For healthcare professionals, particularly doctors and healthcare managers, understanding and leveraging these technologies can lead to more informed decision-making, improved patient outcomes, and an optimized revenue cycle. This article delves into how data analytics and predictive …
Metrics and KPIs to Track in Revenue Cycle Management
Revenue Cycle Management (RCM) is an integral component of the healthcare industry, ensuring that healthcare providers efficiently manage patient care revenue from initial appointment scheduling through to the final payment collection. Effective RCM not only supports the financial health of healthcare providers but also enhances patient satisfaction by streamlining billing processes and reducing errors. This article explores critical metrics and Key Performance Indicators (KPIs) that are essential for monitoring and optimizing every phase of the revenue cycle. By focusing on these metrics, healthcare organizations can identify areas for improvement, reduce costs, increase efficiency, and ultimately drive revenue growth. Understanding Revenue Cycle Management Revenue Cycle Management encompasses the administrative and clinical …
MIPS: The Day of Reckoning
One of my favorite books is The Big Short by Michael Lewis. It was eventually made into a movie by the same name and gives a clear view of the housing bubble that burst 10 years ago and pushed the US economy into the Great Recession. What fascinates me was the ability of some to predict, and profit, from knowing when the collapse would occur. They were able to delve into the details of millions of mortgages and see when the adjustable rates would suddenly increase leading to escalating mortgage payments and boosting the default rates dramatically. The subsequent collapse was unavoidable, and predictable. What does this have to do …
Are Biometrics the Future of HIPAA Security?
Medical electronic health records, or EHRs for short, may have the potential to be much more secure than conventional records. That sounds like a bold claim in light of news about data breaches involving personal information. In fact, according to a report from the Identity Theft Resource Center and CyberScout, the number of tracked data breaches in the United States in 2016 hit an all-time high of 1,093. And still, more than 78% of doctors use EHRs, says the CDC. For medical professionals and the healthcare industry as a whole, keeping sensitive data secure and adhering to HIPAA regulations is a top priority. After all, EHRs can include years of …
The Latest Details on HIPAA Compliance Audits
Deven McGraw, deputy director of the Department of Health and Human Services’ Office for Civil Rights has announced that the department’s plans for initiating onsite audits is currently on hold and will remain so until more than 200 desk audits have been completed. An article over on Data Breach Today gives us great detail on where HIPAA compliance audits stand with their enforcing agency. McGraw informed the HIMSS17 conference in February of the delay. We have decided that it makes a lot more sense to [first] take a look at all we had in the desk audit process and even prepare the overarching report to the public about how those …
