News

By Lynda M. Johnson, Timothy C. Ezell and Tonya S. Gierke Published in Arkansas Medical News (March/April) It is no secret that there are extensive challenges facing healthcare providers in today’s regulatory environment. In particular, the significant increase in government healthcare program audit activity over the last 10 to 15 years has created additional uncertainty and risk in the healthcare industry.

In the January/February 2018 issue of Arkansas Medical News, healthcare attorneys Lynda Johnson, Timothy Ezell and Tonya Gierke begin a series titled "The Anatomy of an Audit." The series will appear bimonthly in the magazine and will discuss various audits and offer suggested courses of action.

The attorneys at Friday, Eldredge & Clark recommend hospitals and healthcare providers perform quarterly audit reviews to provide assurance that their financial and operational controls are sufficient and to identify and repair any potential risk to the organization.

The Arkansas Health Information Management Association hosted a half-day workshop focused on legal issues in the industry. Attorneys Lynda Johnsonand Tonya Gierke presented at the event. Topics discussed included an overview of legal health records, responding to subpoenas, the retention and destruction of health records, HIPAA security rule and audits and amendments to electronic health records.

While the Federal Government has many contracted auditors to assist in identifying overpayments to health care providers, by far the most dangerous of these auditors, from the health care provider’s perspective, is the ZPIC. 

New reporting requirements for healthcare providers are scheduled to go into effect in January 2018 as a result of the mandate in Section 218(b) of the Protecting Access to Medicare Act of 2014 (PAMA). PAMA requires CMS to establish a program to promote ordering physicians to consult “appropriate use criteria” (AUC) prior to ordering advanced diagnostic imaging tests for Medicare beneficiaries.

Measuring Compliance Program Effectiveness The Office of the Inspector General (OIG) recently posted new compliance guidance to assist healthcare entities of all types and sizes of measuring the effectiveness of their compliance programs. The publication, “Measuring Compliance Program Effectiveness: A Resource Guide” was the collaborative result the Health Care Compliance Association and the OIG.