Understanding OIG Compliance

BackgroundOn October 15, 1976, President Ford signed into law legislation creating an Office of Inspector General (OIG) at the Department of Health, Education and Welfare (HEW). HEW OIG would become HHS-OIG in 1980 when the Department was redesignated as the Department of Health and Human Services (HHS).The OIG and HHS oversee various segments of t...
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Coalition Targets Root Causes of Health Disparities

The notion that healthcare needs are human needs is gaining ground within the healthcare sector. So is the view of hospitals as important economic anchors that must address these human factors as well as the medical needs of the communities they serve, because the two sets of needs are inextricably linked.A chief catalyst for this broadened view of...
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National Health Expenditures and Federal Funding of Medicaid

2015 National Health Expenditures SummaryIn December 2016, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) issued a study of 2015 National Health Expenditures (NHE). According to the study, overall health spending grew by 5.8 percent in 2015 to $3.2 trillion or about $10,000 per U.S. citizen, and accounted for 17.8...
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Consumers, Employers and Providers Take the Hit from Rising Healthcare Spending

Healthcare is changing so fast it will make your head spin. Keeping up with all the changes is a huge task, even for industry insiders. Recent news reports demonstrate this: Aetna is pulling out of the various state insurance exchanges, as are United Healthcare, Humana and many of the Blue Cross/Blue Shield regional insurers. Insurance companies ar...
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OIG Report Reveals Two-Midnight Rule Vulnerabilities

A study by the Office of Inspector General (OIG) has revealed "vulnerabilities" under the Two-Midnight hospital policy that initially went into effect on October 1, 2013. In response to the findings, OIG has recommended that the Centers for Medicare and Medicaid Services (CMS) improve oversight of hospital billing under the policy and take steps to...
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Healthcare Industry Strategic Trends: Takeaways from the JP Morgan Healthcare Conference

Last week, MiraMed's senior executives attended the JP Morgan Healthcare Conference in San Francisco along with top executives from more than 450 private and public companies in biotech, pharmaceutical, medical device and technology, as well as healthcare providers, payers, private equity and venture capital firms. Presentations provided a glimpse ...
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Healthcare’s Newest Security Threat: IoT

One of the greatest technological achievements in the 21st Century was is the creation of the Internet. Its formation has effectively changed almost every aspect of business and personal communication.The newest threat to cybersecurity is the proliferation of Internet of Things (IoT)—connected physical and smart devices that have embedded technolog...
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Study Shows How to Meet the Needs of Complex High-Need Patients

Hospitals and health systems can make a more meaningful dent in the costs of care and improve the value of the care they deliver by zeroing in on the social and behavioral health needs of their most complex high-need patients, according to a new report published by The Commonwealth Fund.The problem isn't that these individuals lack access to medica...
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Veterans Affairs Issues Final Rule Expanding Practice Authority

On December 14, the Department of Veterans Affairs (VA) published a final rule amending its medical regulations to expand the scope of practice for certain Advanced-Practice Registered Nurses (APRNs) at VA facilities. The VA believes the rule, which becomes effective January 14, 2017, will make it easier for veterans to be seen by medical professio...
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2016 Healthcare Year in Review

The spotlight on the healthcare industry grows brighter every day. The industry is facing immense scrutiny on every aspect of the clinical and business drivers. Healthcare delivery is morphing from a fragmented multi-organizational industry to a more consolidated business structure where major players are merging or acquiring smaller entities. This...
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Ensuring Access to Care in Urban and Rural Communities

A report from the American Hospital Association (AHA) outlines emerging strategies to help hospitals in rural and urban communities strengthen their viability in the current environment and preserve their ability to deliver services to vulnerable populations.Developed by a 29-member task force of hospital and health system leaders and state hospita...
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Settlement Offer Announced for Appealed Medicare Claims

Review of Appeals Process and Current BacklogMedicare Administrative Contractors process an estimated 1.2 billion fee-for-service claims each year on behalf of the Centers for Medicare & Medicaid Services (CMS) for more than 33.9 million Medicare beneficiaries. Of the 1.2 billion claims filed in 2015, 123 million or about 10 percent were denied...
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Separating Fact from Fiction in Healthcare Medical Chart Auditing

Chart auditing programs have become more important in light of increased federal payer audits. As a result, many providers want assurances that their medical chart documentation is accurate and is descriptive of the provided medical services. Validating processes and functions in a healthcare setting follows the same principles as fact checking a n...
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A Timely, Transparent Response to Unexpected Harmful Events

"We realize mistakes happen, and we can forgive that," says patient advocate Carol Hemmelgarn, whose nine-year-old daughter died of medical error and a hospital-acquired infection (HAI) in a teaching hospital. "But you harm us again by not being honest and transparent with us . . . we should be healing and learning together how to prevent this from...
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Data Released on Medicare Bonuses

WikiLeaks: The Hacker's HackerAccording to federal data released November 1, more than 1,600 hospitals will see bonuses from Medicare in 2017 under the Hospital Value-Based Purchasing (VBP) Program; about 200 fewer than last year.Program BackgroundThe Hospital VBP Program was established under the Affordable Care Act in 2012 as one of many initiati...
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WikiLeaks, Hackers and Cybercriminals Keep Healthcare IT Stakeholders on Guard

WikiLeaks: The Hacker's HackerYou would have to be living completely off the grid to be unfamiliar with WikiLeaks, the multi-national media organization founded by Julian Assange. WikiLeaks has elevated itself as the most well-known name in hacking, exposing classified, censored or otherwise restricted official materials involving war, spying and c...
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The Essentials of Emergency Preparedness

In slightly less than a year (by November 15, 2017), healthcare entities that participate in Medicare and Medicaid will be required to meet the provisions of the Centers for Medicare & Medicaid Services' emergency preparedness final rule.In a recent webinar hosted by Hospitals & Health Networks, Regina Phelps, founder of Emergency Managemen...
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Final MACRA Rule Released by CMS

In an e-Alert released last month, we noted that the Centers for Medicare and Medicaid Services (CMS) would soon be issuing a final rule relating to the Medicare Access and CHIP Reauthorization Act (MACRA). That final rule was issued this past Friday, and includes changes and clarifications responsive to over 4,000 public comments."This is a landma...
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Deconstructing Healthcare Consumerism

Consumerism and Personal Debt AccumulationMerriam-Webster defines consumerism as the promotion of the consumer's interests and it states that an increasing consumption of goods is economically desirable. The United States has become a society of increasing consumerism, where individuals are making increasing levels of purchases for a variety of con...
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A Framework for Tackling Health Disparities

SummaryIn the introduction to its new white paper, Achieving Health Equity: A Guide for Health Care Organizations, the Institute for Healthcare Improvement (IHI) tells the story of Tommy Cannon, a black American with type 2 diabetes and no access to preventive healthcare, who died in 1973 at the age of 62. Cannon waited hours in a segregated physic...
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