2014 Thought Leadership Archives
- December 2, 2014 | “Risk Adjustment Data Validation Audits: The Compliance Team’s Role”
~from Compliance Today | By Lisa DiSalvo, Vice President, Product Strategy & Development, Altegra Health.
With the first audit still six-plus months away (the expected start date is June/July 2015), there are many activities that the compliance team can begin today to streamline the audit process and minimize unwanted surprises in the audit results.
- November 1, 2014 | “Unallowable Costs Related To A Corporate Integrity Agreement”
~from Compliance Today | By Jeannie O’Donnell, CIA, CISA, CHC, Senior Consultant, Reimbursement & Advisory Services, Altegra Health.
In contracting with the government, the government regulation for unallowable costs, general accounting practices, and other financial rules is FAR 31.2, Cost Principles for Commercial Organizations. Failure to comply with FAR 31.2 results in significant burden and financial exposure.
- September 10, 2014 | “Provider Education and Training for ICD-10 Implementation”
~from New Perspectives | Association of Healthcare Internal Auditors | By Lynn Handy, Senior Director of Professional Coding Services and Education, Altegra Health.
Implementation of ICD-10 has been delayed, but now is not the time to take your foot off the accelerator. When the new coding system receives the green light, ICD-10 diagnosis codes will be the basis of reimbursement. Successful implementation depends on quality documentation.
- September 1, 2014 | “The Value of Transparency in Health Care Quality Performance”
~from Managed Care Outlook | By Rand Hager, Product Manager, Quality Performance, Altegra Health.
When health plans or managed care organizations submit quality measures to the National Committee for Quality Assurance (NCQA), the Centers for Medicare & Medicaid Services (CMS), a state, or other entity, there are complex processes, assumptions, decisions, and equations that go into producing each individual result. Transparency into these multifaceted calculations is becoming more important for quality managers in the managed care environment.
- July 1, 2014 | “What Every Compliance Officer Needs To Know About Human Resources”
~from Compliance Today | By Ana Dunham, Compliance Officer, Hannibal Regional Healthcare System and Sharon Blackwood, Independent Compliance and Privacy Professional.
Compliance officers have many opportunities to collaborate on issues with the HR department. The Compliance/HR team provides an effective safety net for the organization.
- June 19, 2014 | “How ACOs and Payers Are Using Your Data to Radically Change the Practice of Patient Care”
~from ADVANCE for Health Information Professionals | By Evan Hetu, Senior Vice President, Data & Analytics, Outcomes Health Information Solutions, an Altegra Health Company.
Although many provider organizations are not directly involved in advanced analytics, it is crucial that they stay abreast of these processes, especially if they are positioned to benefit from financial rewards within a value-based care model.
- June 11, 2014 | “The Initial Validation Audit: Crucial Component of Risk Adjustment Under ACA”
~from Health Insurance Report | By Lisa DiSalvo, Senior Director of Product Development, Altegra Health.
The Affordable Care Act (ACA) risk adjustment data validation audit (RADV) begins summer 2015, giving ACA-health plan executives less than 12 months to prepare for this extensive requirement. Early and thorough preparation can smooth audit operations, mitigate operational pressure and reduce negative financial impact.
- June 1, 2014 | “The First Critical Hours: What Compliance Officers Need to Know About Crisis Communication”
~from Compliance Today | By Cynthia M. Perrone, JD, HIA, FLMI, AIRC, Vice President, Legal & Regulatory Compliance, Altegra Health; and Jeff Boone, MBA, Vice President, Marketing Communications, Altegra Health.
Every company, even one with the best intentions and reputation, is becoming increasingly vulnerable to risks and, as a result, organizational crises. It’s just a matter of time for some organizations. So, what makes some compliance officers better at handling crisis management communications than others? The simple answer is proactive preparation before the crisis.
- April 1, 2014 | “Verifying Whether Clinical Co-management Compensation is Consistent With Fair Market Value”
~from Compliance Today | By Curtis Bernstein, ASA, CPA/ABV, CVA, MBA, Managing Director of Valuation and Transaction Services, Altegra Health; Allison Carty, JD, MBA, Valuation Manager, Altegra Health; and Bobby Stamper, MBA, Valuation Services Analyst, Altegra Health.
With the passage of the Patient Protection and Affordable Care Act and the implementation of reimbursement methods that shift more risk to providers, a number of health systems have executed or are considering executing clinical co-management agreements.
- March 12, 2014 | “A Primer on Fair Market Value and Physician Employment Arrangements”
~from New Perspectives on Healthcare Risk Management, Control and Governance | By Curtis Bernstein, ASA, CPA/ABV, CVA, MBA, Managing Director of Valuation and Transaction Services, Altegra Health; Allison Carty, JD, MBA, Valuation Manager, Altegra Health; and Monica Nunez, JD, Analyst, Altegra Health.
Before you audit, learn the basics and risks of employment arrangements.
- March 1, 2014 | “DME Scrutiny Increases: Fix Documentation Misses”
~from Healthcare Business Monthly | By Kelly Loya, CPC-I, CHC, CPhT, CRMA, Director of Reimbursement & Advisory Services, Altegra Health.
Although determining supply codes is pretty straightforward, diagnosis coding and medical necessity is not.
- February 10, 2014 | “The Language of Collaboration”
~from Journal of Health Care Compliance | By Cynthia M. Perrone, JD, HIA, FLMI, AIRC, Vice President, Legal, Corporate Quality & Regulatory Compliance, Altegra Health.
How In-house Counsel, Outside Counsel, and Compliance Officers Facilitate Communication.