2013 Thought Leadership Archives

  • December 1, 2013 | “What Every Compliance Officer Should Know About Release of Information”
    ~from Compliance Today | By Sharon Blackwood, Independent Compliance and Privacy Consultant; and Sheila P. Limmroth, CIA, CHC, Corporate Director of Internal Audit & Compliance for DCH Health System.
    Compliance officers have constant learning curves. The release of information (ROI) process involves familiarity with a variety of regulations.
  • November 15, 2013 | “Audit Committee’s Role in Compliance”
    ~from Compliance Today | By Kelly Nueske, RN, CPA, CMA, CIA, CRMA, CHC, Managing Director, Altegra Health.
    Recent scandals have created higher expectations for the compliance responsibilities a board must shoulder.
  • September 16, 2013 | “Professional Fee Coding Audit: The Basics”
    ~from New Perspectives on Healthcare Risk Management, Control and Governance | By Lori Carlin, CPC, CPC-H, ACS-E/M, Manager, Reimbursement & Advisory Services Division, Altegra Health; and Kristen Taylor, CPC, CHC, Managing Consultant, Reimbursement & Advisory Services Division, Altegra Health.
    This article describes what a professional fee coding audit is and why it should be performed, and helps you identify who should perform it and what should be audited. Different scoring models are offered to help you decide how often to audit and identify possible elements to include in reporting results.
  • August 27, 2013 | “Dear Labby: The Result, the Methodology, the Payer — Why It Matters”
    ~from ADVANCE for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, Senior Consultant, Altegra Health.
    This article provides some clarification on drug testing codes, specifically since creation of the G codes.
  • August 15, 2013 | “Laying the Foundation for Financial Success during Open Enrollment in the Commercial Exchange Market”
    ~from Compliance Today | By Lisa DiSalvo, Senior Director of Product Development, Altegra Health.
    This article provides practical solutions to establish an enrollee conversion and retention strategy that improves financial performance and presents four corners of the foundation for new enrollee financial success.
  • August 1, 2013 | “Putting ‘Effective’ Into Your Compliance Program: Implementation is More than a Word”
    ~from Compliance Today | By Kristen R. Taylor, CPC, CHC, Managing Consultant, Altegra Health Reimbursement & Advisory Services; and Sharon Blackwood, Independent Compliance and Privacy Consultant.
    Today, with the resurgence of the Responsible Corporate Officer Doctrine, corporate officers are held to a much higher standard. More than ever, you need to be sure you have an effective compliance program.
  • June 10, 2013 | “Physician and Nurse Practitioner Billing: Are You Getting it Right?”
    ~from New Perspectives on Healthcare Risk Management, Control and Governance | By Brent Freeman, CIA, Manager of Internal Audit for DCH Health System; and Kelly Loya, CPC-I, CPhT, CHC, Director of Reimbursement & Advisory Services, Altegra Health.
    Is your facility capturing the maximum reimbursement for the services provided by Nurse Practitioners?
  • June 1, 2013 | “Billing Compliance Under the Incident To Provision”
    ~from Compliance Today | By Kelly C. Loya, Director, Reimbursement & Advisory Services, Altegra Health; and Cara L. Friederich, Senior Consultant, Professional Reimbursement and Coding Services, Reimbursement & Advisory Services, Altegra Health.
    Working independently under their state scope of practice, non-physician practitioners (NPPs) can bring increased care opportunities, access, and revenue to a practice. However, with increased revenue potential comes increased risk. Pay particular attention to how these services are provided, documented, and reported for appropriate reimbursement.
  • May 16, 2013 | “Dear Labby: How to Avoid Anti-Kickback Statute Implications”
    ~from ADVANCE for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, senior consultant in the Reimbursement & Advisory Services Division of Altegra Health.
    This ‘Dear Labby’ question concerns a the practice of a large, private lab that woos customers away from a hospital by providing a phlebotomist at the clinician’s office who frees office staff from having to perform clerical details or perform other mundane tasks.
  • April 8, 2013 | “Dear Labby: Reimbursement Rates”
    ~from ADVANCE for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, senior consultant in the Reimbursement & Advisory Services Division of Altegra Health.
    This ‘Dear Labby’ question concerns the grey area of billing a client less than Medicare/Medicaid reimbursement.
  • April 5, 2013 | “Managing the Burden of HCC and HEDIS Reporting – A Lesson in Streamlining”
    ~from BNA’s Medicare Report | By Omid B. Toloui, senior director of product management at Altegra Health.
    Chart review is an intensive and expensive process that costs Medicare Advantage (MA) plans millions of dollars each year. Today, innovations and improvements in review processes are streamlining these audits, thereby increasing the value of the data collected and reducing the expenses associated with documentation review.
  • April 1, 2013 | “OIG Advisory Opinion 12-22 Offers Guidance on Co-Management Agreements”
    ~from Managed Care Outlook | By Thomas J. Cuccia, CFA, ASA, managing director, Valuation Services Group, Altegra Health Reimbursement & Advisory Services Division.
    Page 10 article explores a typical co-management agreement as one way in which hospitals and doctors are aligning to seek ways to improve quality of care, increase patient and employee satisfaction, and lower costs.
  • March 22, 2013 | “Chart Audits that Reconcile Care Gaps Create Efficiencies”
    ~from Executive Insight | By Jim Dalen, Vice President and Senior Economist, Altegra Health.
    Superior systems excel by collecting prospective data and sharing results among the many teams within a Medicare Advantage insurer.
  • March 4, 2013 | “Dear Labby: CBC Billing”
    ~from Advance for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, Senior Consultant, Reimbursement & Advisory Services Division, Altegra Health.
    This ‘Dear Labby’ column reflects on one of the highest volume tests may also be the source of most billing errors.
  • February 11, 2013 | “Dear Labby: BCR-ABL Capture”
    ~from ADVANCE for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, Senior Consultant, Reimbursement & Advisory Services Division, Altegra Health.
    This ‘Dear Labby’ installment addresses some confusion caused by the introduction of new molecular pathology procedure codes.
  • January 16, 2013 | “Operating Ethically”
    ~from ADVANCE for Medical Laboratory Professionals | By Melissa Scott, CHC, CPC, Senior Consultant, Reimbursement & Advisory Services Division, Altegra Health.
    This ‘Dear Labby’ column offers tips for making a career out of compliance.
  • January 5, 2013 | “The Changing Role of the Executive Assistant”
    ~from Compliance Today | By Valerie Loyola, Executive Assistant, Enterprise Risk Services Division, Altegra Health and Jeff Sinaiko President, Reimbursement & Advisory Services Division, Altegra Health.
    Working in the health care sector requires a skill set and intuition beyond that of general business executive assistants.
See more articles from 2014 or 2012.

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