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It is challenging enough to ensure compliance with Medicare billing rules within your own organization, but don't forget that you also can be drawn into someone else's scam. Federal authorities are cracking down on billing fraud that originates outside your hospital, and if you aren't careful, you can be caught up in the prosecution, with all the attached liability.
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Ironically, the fifth wrong-site surgery occurred at Rhode Island Hospital as it continues working with The Joint Commission's Center for Transforming Healthcare on improving surgical protocols. The hospital volunteered for the project to improve the safeguards to prevent patients from undergoing wrong-site, wrong-side, and wrong-patient surgical procedures.
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While the RAC audits could mean significant financial losses for your hospital, a fraud or abuse lawsuit could cost you more. A lot more, says Cheryl Wagonhurst, partner with Folley & Lardner LLP. Some of the "hottest" issues right now that you should be looking at are:
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In 2007, Premier Inc. began its Quest program, enlisting hospitals to collaborate and evaluate quality, efficiency, safety, and transparency with oversight from the Institute for Healthcare Improvement.
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The director of quality and risk management at Mendocino Coast Hospital in Fort Bragg, CA, Susan Bivins, RN, wasn't sure The Joint Commission was going to show up for the hospital's survey.
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It was a marriage of sorts, between two departments credentialing and quality improvement. Two departments that hadn't known each other well before. Two departments that came together for a common goal.
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News: A woman presented at a hospital emergency department with complaints of headaches, blurry vision, and shortness of breath. Her work-up included a CT scan of her head, chest X-rays, and routine blood tests.
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Lean management techniques helped Lahey Clinic Medical Center, North Shore, in the city of Peabody, MA, boost patient satisfaction and reduce emergency department (ED) waiting times.
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As if the False Claims Act (FCA) wasn't already enough of a headache for risk managers, recent changes to the law could bring even more reason to worry. Risk managers should be aware of how the Fraud Enforcement and Recovery Act of 2009 (FERA) will affect them, says Richard Glovsky, JD, a partner with the Boston-based law firm Prince Lobel.
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Risk managers are obligated to take the proper steps to detect fraudulent activity and to avoid becoming a naive conspirator, says Steve Lee, an investigator with Steve Lee & Associates, a forensic accounting and litigation consulting firm in Los Angeles. He has consulted on a number of high-profile fraud cases and says risk managers can reduce their vulnerability to billing scams with a few simple precautions.
