The medical tourism industry continues to grow and, as a result of the rising costs of medical procedures in the United States, Central Europe, and other developed nations, patients and…
HIPAA Compliance Requirements
HIPAA settlement payments hit an all-time high in 2018 following year-long HIPAA compliance requirements audits conducted by the Department of Health and Human Services Office for Civil Rights. These monetary…
Outcome-Based Reimbursement
A lot is said these days about Outcome-Based Reimbursement in healthcare. But what exactly is that, and how does it work? Let’s take a look. Five years ago, most of…
Measuring Compliance Program Effectiveness – 3 Critical Questions
There have been several resources for measuring compliance program effectiveness. The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) put out “Measuring Compliance Program…
Healthcare Revenue Cycle Process
The healthcare revenue cycle process is a non-organic process – non-organic because steps cannot be reversed, skipped or circumvented to save time or collect money faster. Missing or skipping a…
HIPAA Encryption Requirements or Best Practices
HIPAA Encryption requirements? Not really! To be sure, encryption may not always be directly required, but it is often best practices. When it comes to HIPAA compliance, the way you…
Starting a Medical Tourism Business
Starting a medical tourism business is not easy, but mounting changes and regulations in western healthcare systems have prompted a boom in medical tourism. In fact, according to a recent…
Fee-for-Service vs. Value-Based Reimbursement
The cost of medical care has outpaced inflation for several years now, and it shows no signs of slowing. Despite skyrocketing costs, care quality is not improving under the traditional…
OIG Workplan 2019: What’s New!
We are entering the second year of the OIG’s new approach to publicizing and managing its FY18-19 Workplan. Just like last year, the OIG Workplan 2019 is not a static document. …
Understanding HIPAA Policies and Procedures
In 1996, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA) primarily to protect individuals and their personal health information (PHI) contained in medical records. HIPAA applies to all…
Revenue Cycle Management Outsourcing
According to a recent Black Book Survey, revenue cycle management outsourcing stood at $11.7 billion at the close of 2017 and is expected to climb to $23 billion by 2023….
What is HIPAA Compliance? What You Don’t Know Can Cost You.
If you work in medical billing or healthcare administration, you probably think you can answer the question: What is HIPAA Compliance? Yet, a recent Office of Civil Rights (OCR) audit…
Healthcare Revenue Cycle Flowchart in 5 Steps
Healthcare revenue cycle management is a complex and complicated process that can drain resources when not properly managed. It takes considerable time and expertise to create and manage a well-maintained…
HIPAA Compliance Policy and Your EHR
As many organizations have found out the hard way, there is an important relationship between HIPAA compliance policy and your Electronic Medical Records (EHR). Consider these recent headlines: 100 million…
Value-Based Care Reimbursement
A recent Black Book survey found that hospitals and other providers are gearing up to outsource key functions, including a move to outsource revenue cycle management to third-party vendors. Medical…
A Medical Billing Audit can Increase Profitability
A Medical billing audit is often thought of as a defensive measure. A government or private payor has denied or pended a series of claims. Now they want to review documentation…
HIPAA Requirements – and how to be in compliance
Many articles and blog posts mention HIPAA compliance, but what are HIPAA requirements, and what do you have to do to be compliant? What is the security rule? The privacy…
Strategic Planning in Healthcare – 12 Crucial Questions
Strategic planning in healthcare starts by measuring end goals against your current standing. It examines obstacles that sit between where your healthcare organization is and where it should be. When…
Physician Revenue Cycle Key Indicators of Best Practices
Physician revenue cycle operations continue to transform fundamental aspects of modern medical practice. The current unsustainable system drafts individual elements of the revenue cycle in search of success, often ignoring…
What is Value Based Reimbursement Looking Like in 2019?
Change is a constant in the healthcare industry, and for all healthcare providers submitting claims to Medicare, it’s important to carefully review your processes based on what’s to come with…