Posts Tagged ‘Compliance’

The Federal Trade Commission’s (FTC) compliance deadline for creditors and financial institutions to develop and implement an identity theft prevention program under the Red Flags Rule was delayed—yet again. The implementation date originally set for Nov. 1, 2008 has been delayed three times to 2009 dates: May 1, Aug. 1, and Nov. 1. At the request of Congress members, the latest implementation date now extends to June 1, 2010.

There has been question as to how the Red Flags Rule applies to health care providers. According to the FTC’s Fighting Fraud with the Red Flags Rule: A How-To Guide for Business, page 9-10, “The definition of ‘creditor’ is broad and includes businesses or organizations that regularly defer payment for goods or services or provide goods or services and bill customers later. Utility companies, health care providers, and telecommunications companies are among the entities that may fall within this definition, depending on how and when they collect payment for their services.”

To help determine if you should comply under the Red Flags Rule, the FTC offers resources on their Web site. The FTC’s resources also include an FTC compliance template and information on how to design and implement an identity theft prevention program. The American Medical Association (AMA) also has prepared a sample policy template for providers.

For excellent coverage on the Red Flags Rule, read pages 18-19 in the February 2009 issue of Coding Edge.

In reviewing the criteria required for Certification Commission for Health Information Technology (CCHIT) credentialing, the American Academy of Professional Coders (AAPC) uncovered multiple areas for concern. Many of the CCHIT requirements conflict with federal mandates for correct coding or with what AAPC promotes as appropriate coding principals.  Read more »

Recently the news was released that CMS was going to replace the 30-year-old ICD-9 code set with ICD-10, and even though we have an October 1, 2013 deadline it is not too soon to start preparing.  Topping off the necessary steps to ICD-10 conversion is the implementation of a new 5010 security set that begins on January 1, 2012. Read more »

The Federal Trade Commission (FTC) will suspend enforcement of the new Red Flags Rule until May 1, 2009. This gives financial institutions and creditors (as well as medical practices) additional time to implement written identity theft prevention programs. The Enforcement Policy Statement release does not affect other federal agencies’ enforcement of the original Nov. 1 deadline for institutions subject to compliance. Read more »

A recent U.S. Supreme Court ruling re-affirms liability under the federal False Claims Act (FCA) regardless of whether the person causing the submission of false claims to the government financially benefitted from their actions. The ruling denied a petition requesting the review of an appeal’s court decision to allow a Qui Tam suit against state officials involved in federal-state programs such as Medicaid under the federal False Claims Act (FCA) (Wilcox v. United States ex rel. Stoner, U.S., No. 07-1336, review denied 10/6/08). Read more »

A recent OIG report found that more than one-third of all modifier 25 claims it had reviewed failed to meet coding requirements, learning to improper payments of $538 million in one year alone. This article explores three rules that will help you increase compliance and avoid improper payments.

Full Article

With health care providers operating under increased regulatory scrutiny, you can never be too prepared for recovery audit contractors (RACs). Before you land yourself in an auditing pickle that costs you more than you can afford to loose, HCPro Revenue Cycle Institute’s The RAC Report Tips to Prepare for RACs has a starting place to help your practice or facility get ready for RACs.

Remember: Good coding is your best RAC protection.