The Compliance and Accuracy Series: Mastering Healthcare Billing & Coding

  Audits are essential to healthcare management, ensuring compliance, accuracy, and efficiency in billing and operational practices. However, an audit can be intimidating for healthcare providers and administrators alike. Preparation is the key to alleviating this fear. By implementing audit-ready practices, you can transform audits from a source of stress into an opportunity to improve your practice. In this blog, we’ll explore practical steps to prepare for audits, outline the benefits of being audit-ready, and provide actionable insights for healthcare providers and management teams. What Does It Mean to Be Audit-Ready? Being audit-ready means having systems, processes, and documentation in place to ensure compliance with healthcare regulations, payer requirements, and coding standards. This includes maintaining accurate records, conducting internal audits, and having policies in place to address discrepancies proactively. Steps to Prepare for an Audit 1. Maintain Accurate D...

View the Checklist here: Compliance Checklist

  Healthcare compliance is more than just a legal obligation; it’s the backbone of trust, quality care, and operational success in any medical or dental practice. Whether you’re a solo provider or part of a large organization, understanding and implementing compliance practices can protect your patients, your practice, and your reputation. In this blog, we’ll explore the key elements of healthcare compliance, why it’s critical for providers and actionable steps to establish a strong compliance foundation in your practice. What is Healthcare Compliance? Healthcare compliance refers to adhering to laws, regulations, and guidelines that govern healthcare operations. These standards ensure patient safety, data privacy, and ethical practices while minimizing fraud, abuse, and operational risks. Key regulatory frameworks include: HIPAA (Health Insurance Portability and Accountability Act): Protects patient health information. OIG (Office of Inspector General): Prevents fraud and abuse ...

  Re-Credentialing: What It Is and Why It Matters for Your Healthcare Practice In the world of healthcare administration, credentialing is a cornerstone of maintaining payer relationships and ensuring smooth revenue cycles. But did you know that re-credentialing is just as critical? This often-overlooked process is essential for sustaining your in-network status, avoiding disruptions in patient care, and maintaining compliance with payer regulations. Whether you’re a solo provider, part of a group practice, or a healthcare administrator, understanding the re-credentialing process can save you time, money, and stress. What is Re-Credentialing? Re-credentialing, also known as re-validation , is the periodic process payers use to verify that a healthcare provider still meets their network’s requirements. Most payers require re-credentialing every 2 to 3 years , depending on their policies and federal or state regulations. During re-credentialing, payers review your: Licenses (e.g.,...