YouCompli

🚨NEW BLOG ALERT🚨 Advancements in medical diagnosis and treatments often begin with clinical research and services performed at academic medical centers. Yet most compliance pros don’t realize there are unique compliance issues involved with research and services in academic settings. Here are three of the issues. 🔸Issue 1: Teaching Physician Billing Rules Academic medical centers usually offer graduate medical education (GME) where recent graduates can train in a specialty as part of a residency. Medicare makes GME payments to support these new physicians’ residencies and training – but does not allow additional payment to attending or supervising physicians unless they are involved in direct patient care and meet certain requirements. These requirements are often known as teaching physician billing rules. 🔸Issue #2: Clinical Trial Billing Academic medical centers are frequently involved in clinical research through participation in clinical trials. When medical services are provided in conjunction with these clinical trials, some may be reimbursable by Medicare (for example) and other services might not. These coverage rules are explained in a Medicare National Coverage Determination (NCD) titled “Routine Costs in Clinical Trials (310.1).” By not following these rules, and billing Medicare for services that should have been billed to other entities such as a clinical trial sponsor, organizations can get themselves into compliance trouble. 🔸Issue #3: Conflict of Interest Disclosures Many recipients of grants awarded by the National Institutes of Health (NIH) are researchers at universities and academic medical centers. These federal dollars come with many requirements, including accurate and truthful conflict of interest disclosures – especially as they may relate to any influence or collaboration with foreign actors or organizations. If you work in or partner with an academic medical center, these three unique scenarios are likely to come into play. Be sure you have a plan for ensuring compliance with them or create and implement one at your earliest opportunity. Read CJ Wolf, MD, CPC, CPC-I's full article here ➡️ https://hubs.la/Q02Wg-W_0 #compliance #healthcare #coding #academic #research

🚨 NEW YouCompli BLOG 🚨 Leaders in compliance often come from a variety of backgrounds, each bringing unique perspectives and skills to the table. Whether their expertise lies in law ⚖️, business management 📊, or clinical care 🩺, these professionals play a critical role in ensuring that healthcare organizations meet their regulatory obligations while maintaining high standards of patient care and operational efficiency. Let’s review how the backgrounds of compliance leaders in legal, business (MBAs/MHAs), and clinical fields often shape their approach to compliance leadership, and why each’s approach is valuable. 💠Legal Background: Navigating Regulations with Precision ⚖️ Compliance leaders with a legal background have significant experience working with healthcare laws and regulations. Their strength lies in their deep understanding of regulatory frameworks, including the nuances of state and federal laws such as HIPAA, the False Claims Act, and Stark Law. 💠Business Background: Strategic, Big-Picture Thinkers 📊 Compliance leaders with a background in business – often holding MBAs or MHAs – bring a different perspective focused on strategy, operations, and organizational efficiency. These leaders often have experience in healthcare administration or executive management, which gives them a comprehensive understanding of the business side of healthcare. 💠Clinical Background: Patient-Centered and Ground-Level Insight 🩺 Compliance leaders from clinical backgrounds, such as nurses, physicians, or other healthcare providers, bring an invaluable, patient-centered perspective to compliance management. Their experience in direct patient care allows them to understand how compliance affects both patient outcomes and day-to-day operations. Healthcare compliance is a multifaceted challenge, and compliance teams benefit from having people from diverse leadership backgrounds. Leaders with legal, business, and clinical expertise each bring unique strengths to the role, ensuring that compliance initiatives are legally sound as well as strategic and patient-centered. The most successful compliance programs often come from a collaborative approach, where legal precision, business strategy, and clinical insight intersect to create a robust framework that promotes both regulatory adherence and high-quality care. Regardless of who is leading the team, it’s critical to include staff on compliance teams from all backgrounds. No single background has all the answers, but by combining the strengths of these diverse perspectives, healthcare organizations can navigate the complexities of compliance with agility and confidence. Read Amy L.'s full article and explore other helpful articles here ➡️ https://hubs.la/Q02Vtnv30 #compliance #healthcare #regulation #diversity #Culture

🚨 NEW BLOG POST 🚨 Radiology services can be accompanied by some unique compliance challenges that do not always exist with other types of health care services. The following tips can help compliance professionals as they develop strategies to monitor compliance associated with typical radiology services. Tip 1️⃣: Document Clinician Orders for Diagnostic Tests Tip 2️⃣: Document Medical Necessity for Imaging Services Tip 3️⃣: Read, Understand, and Follow Local Coverage Determinations Tip 4️⃣: Know the Rules for Teaching Physicians in Radiology Radiology services have unique characteristics, and some unique compliance considerations that accompany them include compliance rules associated with physician orders, medical necessity, local coverage determinations, and teaching physician settings. Compliance professionals need to be aware of these and others as they develop strategies to follow rules and regulations associated with typical radiology services. #compliance #healthcare #coding #Medicare #radiology 📘 Read CJ Wolf, MD, CPC, CPC-I's full article and download the tip sheet here ➡️ https://hubs.la/Q02TQs6s0

🚨 NEW BLOG POST 🚨 In a football game, the Fourth Quarter can define the moment for either the team defending its lead or the team trying to reverse its fortune. Effective play action, clock management, and teamwork help maintain possession and run the clock down. Conversely, the trailing team must regroup and often change its game plan. 🏈 Similarly, a Compliance Officer is accountable to leadership and the Board for the compliance program’s effectiveness. This depends on accurate data to assess the team’s status and plan the best path forward. As the Fourth Quarter approaches, compliance initiatives must be evaluated before the year’s end. 📊 The coach and key players typically provide a wrap-up at a post-game news conference, offering insights into the team’s plays and outcome. Similarly, one key Fourth Quarter responsibility for the Compliance Officer is producing the Annual State of the Compliance Program Report. This report provides valuable insight into the organization’s compliance with laws, regulations, and industry standards, highlighting control weaknesses and compliance risks. 📋 A valuable Annual Report demonstrates credible outcomes of the compliance program’s progress and planned enhancements for the next year. It highlights opportunities for improvement and planned actions to enhance effectiveness. 📈 Leadership and the Board need the necessary information to ask informed questions and carry out strategic objectives. While the Annual Report offers an overview, the Compliance Officer must also provide detailed reporting on program initiatives. 📝 Successful teams produce fan satisfaction and revenue for stakeholders. High-quality compliance programs protect the organization from non-compliance consequences and contribute to quality patient care and financial success. 💼 As we enter the Fourth Quarter, both football coaches and Compliance Officers must take inventory, assess progress, and report results to demonstrate positive outcomes. This review will reveal accomplishments and future opportunities. 🚀 Read Susan Thomas' full article here: https://hubs.la/Q02SLGnr0 #compliance #healthcare #FourthQuarter #OIG

There was a lot of buzz about regulatory compliance and revenue cycle at the recent HFMA Region #6 Conference! We were excited to meet so many revenue cycle professionals and discuss their challenges and opportunities. (Many even got our fun t-shirts😉). Thanks to the Healthcare Financial Management Association (HFMA) Region #6 Conference team for putting on a great event! #compliance #revenuecycle #RCM #HFMA

The healthcare revenue cycle serves as the lifeblood of medical practices and healthcare facilities, directly influencing financial stability and sustainability. It's also a gateway to additional reimbursement opportunities, including bonuses and administrative resources. However, with the growing complexity of healthcare regulations, shifting patient expectations, and stricter payer contracts, there are four key "hot spots" within the revenue cycle that demand heightened attention and review for compliance. Failure to address these may lead to significant challenges. To help navigate these complexities, Maya Turner outlined strategies to optimize reimbursement and highlight the potential for improvement in our latest white paper. Download it here ➡️➡️➡️ https://hubs.la/Q02RcqJj0 Additionally, we want to highlight Maya's fantastic presentation at the Healthcare Financial Management Association (HFMA) Region 6 conference. Thank you, Maya, for sharing your expertise! #RevCycle #RCM #WhitePaper

We had an incredible time at the 2024 CIHQ - Center for Improvement in Healthcare Quality A&R Summit in San Antonio! A huge thank you to everyone who stopped by the YouCompli booth. Your enthusiasm and engagement made the event truly special. 🎉 Congratulations to all the winners of our “I’m just a bill!” themed swag! We hope you enjoy your prizes and remember the fun we had. We’re already looking forward to next year’s event and can’t wait to see you all again. Stay compliant and stay connected! #CIHQ2024 #YouCompli #Compliance #Healthcare 

We had a rootin'-tootin' time at the CIHQ Summit last week! Our friend Jodee Miller from CHRISTUS Health participated in the cattle chase — wearing a YouCompli t-shirt! Bull-ieve you me, the CIHQ rodeo was the place to be! 🤠🐂 Hats off to CIHQ for a tremendous event. Yeehaw! 🎉 #CIHQ

🚨 YouCompli White Paper 🚨 The healthcare revenue cycle is the lifeblood of many medical practices or healthcare facilities, directly impacting financial health and sustainability. It’s also the gateway to various other reimbursement opportunities such as bonuses, utilization, and other administrative resources.   However, with the increasing complexity of healthcare, regulations, patient expectations, and stricter payer contracts, four specific areas within the revenue cycle have become critical focus points or “hot spots.” These require more review and internal scrutiny for regulatory compliance, and can lead to significant challenges if not adequately addressed.   This paper outlines the four main hot spots of the healthcare revenue cycle and discusses strategies to optimize reimbursement. It also underscores the potential for significant improvement in these areas.  Download the white paper here ➡️➡️➡️ https://hubs.la/Q02RcqJj0 #compliance #healthcare #RevCycle #CMS #OIG

We had some members from CHRISTUS Health stop and put on a show for our booth at the CIHQ 2024 Accreditation & Regulatory Summit in San Antonio! Big shout out to: Anitha Sanderson April Gammill  and Jodee Miller - great job! Stop by booth #2 for a chance to win some of our popular swag! Can't wait to see you there 🤠 🎉 #CIHQ