Last October, Palmetto, one of the nation’s largest Medicare Administrative Contractors to the federal government, released their Electronic Comparative Billing Report (eCBR) for 2018 data between April 1 – September 30 that focused on hospice providers’ Non-Cancer Length of Stay (NCLOS) rates.

When health care providers repeatedly fail to reach compliance with the Office of the Inspector General’s (OIG) guidelines, the OIG will issue them a Corporate Integrity Agreement (CIA). Under the CIA process, organizations enter into a mandatory agreement to improve their practices over a five-year time frame with outlined compliance guidelines set forth by the OIG.

Implementing a comprehensive internal audit program will position a facility to actively respond to the ever-changing healthcare regulatory environment. Achieving effective and compliant healthcare functions cannot occur without well-defined and ongoing compliance auditing.

Revenue Integrity is needed by providers to improve revenues and ensure regulatory and contractual compliance. A proactive approach that focuses on rapid assessment and mitigation of risks to your revenue stream should be the objective of organizations. Here are several thoughts on what to consider in your approach...