The healthcare industry is always evolving, and that means constant changes for providers, patients, and even insurance companies. In order to root out fraud, waste, and abuse, payers have rules in place that keep everyone on the same path. Unfortunately, though, if your team is unaware of the latest shifts in compliance and coding, then you could wind up seeing some pushback. It pays off to know what’s going on in your world.
When you want to understand how healthcare is evolving, reach out to Medical Auditing Solutions. Our team knows that your office is only as strong as its compliance knowledge, and we have real solutions to help you shore up your team. Some areas appear to be changing in the next year, including our approach to prior authorization, remote patient monitoring, and chronic care management, so there is a lot to keep up with. Schedule a time to talk about your office’s needs, and we’ll work with you to find a more streamlined, compliant way of doing business.
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Prior Authorization Rules Are Always In Flux
If your team accepts traditional Medicare, then it’s always necessary to know what you’re doing. The government and the CMS (Centers for Medicare and Medicaid Services) want to make sure that everyone is acting appropriately, and they have rules and regulations for that aim. While it’s a necessary part of the process, it can also spell real headaches for a provider’s office.
Well, starting on January 1st, there’s another set of important rule changes coming to prior authorization. CMS has identified services with a high rate of improper payment, and they are taking action. Now, it’s vital to keep notes in great detail; for example, wound care may require a photo along with documentation. Talk to our office about these changes to find out more.
They’re Taking A Hard Look At Remote Patient Monitoring
Efficiency and waste are under the microscope, and with it, remote patient monitoring (RPM). This has become an indispensable tool for providers, especially specialists, but the OIG has stated some concerns over the practice. In their minds, it is too easy for people to use this for fraud and abuse.
This additional scrutiny makes it even more important to keep detailed notes. You might be asked about the frequency of your monitoring, the effectiveness of this care, and even the relationship between provider and patient. CMS also requires that you spend at least 20 minutes a month focusing on what the numbers mean for the patient.
Stay Ahead Of The Curve With MAS
When you have questions about compliance, don’t keep them to yourself. To find out more about how we help providers just like you to find a more effective way forward, call Medical Auditing Solutions at (972) 459-1508 today.