Complimentary Review of 30 Inpatient Records Provident understands the financial pressure hospital organizations across the country are feeling due to increased regulation and shifts in reimbursement methodologies. Every dollar is crucial.  Provident’s Revenue Integrity Audit methodology can help by maximizing revenue capture in a compliant manner.  With years of proven results...

Request for Information On April 14, 2017, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2018 Inpatient Prospective Payment System (“IPPS”) proposed rule including a Request for Information (“RFI”).  The overarching message from CMS is to seek comments to the proposed rule and through the RFI that will...

Provident has been engaged in ongoing DRG audits since the implementation of ICD-10 in October 2015. We have identified potential DRG audit target areas related to our audit work, changes to the ICD-10 codeset, and Coding Clinic updates. We will be posting target area case summaries with suggested audit strategies...

In the last few months, the Department of Health and Human Services Office of Civil Rights (“OCR”) announced several enforcement actions based on alleged violations of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Below is a summary of the recent enforcement actions: Untimely Reporting of a Breach....

Good News for Healthcare: Project Success is Trending Up The Project Management Institute (“PMI”) recently released its Pulse of the Profession 2017 report.  Each year, PMI conducts a global survey of project management professionals and highlights trends within the project management profession in its annual report. The healthcare industry is estimated...

In the Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), the Centers for Medicare & Medicaid Services (“CMS”) propose to revise discharge planning requirements under the Medicare Conditions of Participation.  The objectives of the revisions include improving patient quality of care and outcomes, reducing factors that lead to preventable...

For hospitals that serve rural communities, providing telemedicine services and sharing electronic health systems with non-affiliated healthcare organizations may be commonplace. Because of the rural setting and limited resources available to many patients, the ability to connect with patients and share data outside of the walls of the hospital is...

Federal Government Recovered $3.3 Billion From the Health Care Industry in FY 2016 According to the Health Care Fraud and Abuse Control Program (“HCFAC”) Annual Report (“Annual Report”), over $3.3 billion were returned to the federal government and private individuals as a result of health care enforcement actions in Fiscal...

DocEdge® Communicator was designed as a directed and efficient solution to address the workflow challenges and gaps in the query process.  With the ability to query physicians via their smart phone and two click physician responses that flow directly into the medical record, DocEdge® Communicator integrates and streamlines the query...

CMS grants Vistogard® New Technology Add-on Payment Effective October 1, 2016 The CMS decision means that Medicare will pay up to 50% reimbursement of the cost of Vistogard® in the hospital setting (up to $37,500), and it is expected to stay in place for two years until the cost of...