YouCompli

🚨 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

You might have heard about the Supreme Court’s recent reversal of Chevron doctrine. But you probably don’t know exactly what effect it will have on you, your compliance department and your organization as a whole. Join us for a Health Care Compliance Association (HCCA) webinar on September 30, called “What Does the Reversal of Chevron Deference Mean for Healthcare Compliance?” Experts from YouCompli and HortySpringer will analyze the Supreme Court’s ruling and explore in depth what compliance teams need to be concerned with and watching for the rest of this year and beyond. For more information, and to register in advance, visit https://hubs.la/Q02QNsqn0 #ChevronDeference #Webinar #HCCA #Compliance

When conducting their periodic risk assessments, most compliance professionals use the OIG’s Work Plan or recent DOJ enforcement actions to help determine how best to deploy time and resources on auditing and monitoring efforts. There’s another incredibly helpful resource that some might not be as familiar with: the list of services that Medicare Administrative Contractors (MACs) include in their Target, Probe and Educate (TPE) plan. TPE is designed to help providers and suppliers reduce claim denials and appeals through one-on-one help. According to the Centers for Medicare and Medicaid Services (CMS), TPE’s goal is to facilitate quick improvement and enable MACs to work with providers to identify specific errors and correct them. Here are examples of issues MACs are reviewing. If your organization provides these services, it might make sense for your compliance program to add these issues to your risk assessments, auditing, and monitoring plans. 1️⃣ Submission of claims with the drug Lucentis (HCPCS code J2778) for eye injections. 2️⃣ Submission of claims with Hyaluronan or its derivatives (HCPCS codes J7318-J7332), which are used for intra-articular injections. 3️⃣ Wound Care (CPT codes 11042-11045). One MAC’s TPE review found that a lack of medical necessity was a significant reason for denying the claims. This included lack of: As shown here, TPE information can be a valuable resource for compliance pros and departments to use in designing their audit plans. These TPE plan examples demonstrate specific areas of non-compliance that particular MACs observe for listed services. You can use this information to create your own checklist for compliance audits or proactive monitoring. Read CJ's full article and download the tip sheet here: https://hubs.la/Q02Ql-5R0 #compliance #healthcare #coding #Medicare #TPE