Hayes' Healthcare Blog

Leveraging Peer Collaboration and Information Sharing: 3 Things to Think About

Posted by Robert Freedman on May 24, 2017 at 9:00 AM

An article in Inc. Magazine outlined five reasons why collaboration is crucial. While the article was focused mainly on business organizations, the concept is just as important for those in healthcare generally and for compliance and auditing professionals specifically.

The key reasons for working with peers in your industry are:

  • Self-awareness – Collaboration forces you to clearly describe areas of strength and weakness
  • Scale – “Two heads are better than one”
  • Creative Abrasion – Converting energy from people who are different into positive action
  • Take the long view – Ideas may not have an immediate impact but could be beneficial down the road
  • Learn, learn, and learn some more – Collaboration sets an expectation of continuous learning to expand the knowledge base of the organization.[1]

No person – or organization – has all the answers. The more you can work with peers at similar institutions facing similar challenges, the better the chances you can effectively address and successfully solve them. There are three things to consider that can help energize peer collaboration in your organization.

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Topics: mdaudit, Data analytics, Risk-based audits

4 Opportunities Analytics Can Provide

Posted by Robert Freedman on March 29, 2017 at 9:00 AM

The risks of non-compliance in the healthcare industry have never been greater. In fy2016, the HHS Fraud and Abuse Control Program returned $3.3 billion to the Federal government and private parties. The Department of Justice (DOJ) opened 975 new criminal health care fraud investigations.[1]

In fy2015, Medicare Recovery Audit Contractors (RAC’s) identified and corrected 619,000 claims resulting in $441 million in improper payments - $360 million in recovered overpayments and $81 million in underpayments repaid to providers.[2]

With both top and bottom lines continuing to shrink, you can’t afford to be hit with a massive overpayment penalty or to undercharge for patient activity by hundreds of thousands of dollars.

The key to managing both risk and opportunity is getting into your billing and collections data, and for that you need a robust analytics solution. Here are four opportunities you can take advantage of with a comprehensive analytics program.

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Topics: mdaudit, Healthcare Analytics, Risk-based audits

False Claims Act Penalties Doubling: Time to Beef Up Your Compliance Program

Posted by Robert Freedman on September 28, 2016 at 9:00 AM

If you mistakenly submit a single claim that results in a $100 government over reimbursement, you could now be subject to a penalty of over $20,000, according to the lawyers at Mintz Levin, specialists in healthcare law.[1] And that’s for every single claim.

To quote Alec Baldwin’s character in the famous Glengarry Glenn Ross monologue, “Have I got your attention now?”

The Department of Justice recently passed an interim final rule that has nearly doubled the civil penalties under the False Claims Act (FCA) from an already oppressive $5500 minimum to $11,000 maximum per claim to a minimum of $10,781 and maximum of $21,562. The increases – which went into effect August 1 - are the result of a “catch-up” clause in the 2015 Adjustment Act that amended the Federal Civil Penalties Inflation Adjustment Act of 1990.

The act mandates agency heads to adjust civil monetary penalties based on the difference between the Consumer Price Index in October of the year they were established and October 2015. After this initial catch-up, agencies must make additional annual adjustments, so the costs are only going to increase from these new dizzying heights.

The impact for the healthcare industry is seismic. The cost of any slip up in Medicare and Medicaid claims can be financially disastrous and the doubling of penalties means a doubling of “whistleblower” rewards, so organizations can expect increased scrutiny from employees, former employees and competitors looking to cash in.

To make matters worse, because of the sharing of Medicaid costs, the act incentivizes individual states to pass FCA laws in addition to Federal statutes. The pressure on healthcare organizations to “get it right” when it comes to claims submittal has never been greater. With the financial stakes ratcheted even higher, it may be time to refocus your efforts on compliance.

Here are five ideas to help strengthen your compliance program.

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Topics: billing compliance software, mdaudit, compliance programs

8 Things About Healthcare Analytics That May Surprise You, Part 2 of 2

Posted by Lisa English on June 22, 2016 at 9:00 AM

In last week’s post, Lisa English described the growing importance of healthcare analytics in dealing with large-scale initiatives like population health. She also outlined the important role analytics can play in solving the day-to-day problems of monitoring risk areas, supporting continuous risk assessment, and complementing limited compliance resources that organizations face every day.

In spite of the increased reliance on analytics, Lisa stressed that there is still much we need to learn. She outlined four things about analytics that might surprise you. Here are four more considerations surrounding analytics that you may not have realized.

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Topics: mdaudit, Healthcare Analytics, risk management

8 Things About Healthcare Analytics That May Surprise You, Part 1 of 2

Posted by Lisa English on June 15, 2016 at 10:00 AM

Yes, the terms “big data” and “analytics” are buzzwords, but they clearly highlight a shift toward data-driven decision-making with a real measurable impact on outcomes in many different industries. Savvy digital marketers now mine your digital breadcrumb trail to offer you more of what you like and attempt to discern what you need before you are aware of it yourself. This not only drives sales, but also actually helps consumers - if they aren’t “creeped out” by the “Big Brother is watching” when you post on social media then immediately see ads pick up on a word from your post. 

In the healthcare industry, the move to population health is just one obvious application for sophisticated analytics. As we appropriately engage our best and brightest in solving the core healthcare issues of our society, we find the key questions that analytics can help answer: What treatments drive positive health outcomes for patients? How can we curb wasteful, ineffective healthcare? Ultimately, why does the US spend more on healthcare than all developed nations while getting only mediocre healthcare outcomes when looking at our population as a whole?

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Topics: mdaudit, Healthcare Analytics, risk management

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