Fraud is nothing new, but that doesn’t mean it never changes. Certain parts of the ICD-10 implementation create obstacles for fraud detection. These are a handful of healthcare schemes to be aware 1. EHR-related fraud. As EHR systems become more prevalent, there are increasing issues with fraud related to auto-population. Trussell notes that some systems

Earlier this month, we talked about the potential for longer claims cycles as automated detection systems are temporarily derailed by the ICD-10 changeover. We’ll tackle basic processes on how to avoid a Medicare audit and how coding software can guide you to the right levels first: How to avoid a Medicare audit: 1. Use documentation

All of us in business have, at one time or another, been told to think outside the box. If you’re in healthcare, it’s time to tear the box into pieces and throw it in the trash. The enormous shifts taking place in healthcare and the rapid pace at which they’re occurring means everyone needs to

As a medical billing service, it’s hard to soar with the eagles when your billing software is a turkey. Turkey software is the kind that gobbles up all your time, keeps you pecking around in data entry, and offers no way to help your clients stuff the financial holes so common in manual processes. In

Understanding examples of HIPAA violations will help you avoid falling into similar scenarios. In October, AHMC Healthcare in Alhambra, CA, reported that health information on 729,000 patients was compromised due to the theft of two laptops. Last year, an Arizona physician agreed to pay $100,000 to HHS to settle a HIPAA violation case. HHS’s Office

There a couple of confusing things about immunization coding as it relates to medical billing.  First, there are different codes for the vaccine and the administration. That’s because some vaccines are provided by states for children, and the physician is paid only for the administration. Second, Medicare was not initially developed to provide preventive care,

The ICD-10 changeover is a year away, and pundits are ramping up their rhetoric. True, there’s a lot of work to be done, but looking at the facts is always helpful. Here are 10 things that will be true starting October 1, 2014: Claims will be denied if they include an ICD-9 code. Because it already

Although HIPAA has been in effect for 24 years, confusion remains about some aspects. The passing of the HITECH act in 2009 added a few wrinkles and brought this issue back to the forefront. Do you know the difference between HIPAA and HITECH? The Health Insurance Portability and Accountability Act(HIPAA), sets the standard for protecting

Over 200 million claims are denied every year according to the Social Security Administration… Undeniably, medical billers play extremely crucial roles in our industry. Tasked with a job that requires expert knowledge of the ever-changing regulations, accurate coding and the ability to navigate the many different claims processes of health insurance companies.  They ensure that