Learning Opportunities In some cases, HIPAA resources have not changed in the past fifteen years, yet in some areas, due to changing landscape conditions with advances in technology they have had to make refinements which leads to updated standards and reference documents. At KMC University, we will continue to post HIPAA updates for our library…
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All Aboard! When it comes to HIPAA training, no one is to be excluded, especially the treating physicians. If the workforce member enters the clinic where PHI is stored, or interfaces with the network, applications or devices (even remotely) they should complete HIPAA training. Best way to look at it, if they are on your…
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Just a Yearly Task? Just like a home, the more you put off simple maintenance tasks the more it will cost you. HIPAA requires daily, weekly, monthly, quarterly and yearly maintenance tasks. Depending on the size of the practice, these tasks may be delegated to a single individual or shared among staff members. If you…
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During the audit process, you probably noticed that it all comes back to documentation. A provider should code from the documentation. That means that the procedure code, all modifiers, and the ICD-10 code(s) are based on the documentation (medical record). An Explanation of Benefits (EOB) may be processed by the payer based on procedure code…
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Audit the Appeals Process When developing corrective actions after the EOB audit, you might want to take a closer look at the clinic’s appeal process. KMC University recommends the following steps whether the clinic is filing a formal appeal or a quick and easy request for reprocessing. The compliance officer may want to use these…
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Auditing Leads to Action You might be wondering why we have included additional information on appeals in an EOB audit training. As stated before, each audit should lead to corrective actions. We all can learn from our mistakes. In order for a compliance officer to be able to develop corrective actions that are appropriate, they…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
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