In our first installment of the series, “Navigating Change in Otolaryngology: Strategies for Growth and Success,” we explored the evolving landscape of otolaryngology and highlighted key strategies for adapting to change. Building on that foundation, this second installment delves into the critical aspect of regulatory compliance within ENT practices. From navigating the complexities of the Office of Inspector General (OIG) to ensuring adherence to the Health Insurance Portability and Accountability Act (HIPAA) and Medicare guidelines, ENT clinics face a myriad of compliance challenges unique ..read more

Credentialing is a time-consuming task that verifies a healthcare provider’s qualifications, certifications, experience, and training so they can practice. The application is detailed, and the requirements change frequently. If even the tiniest human error occurs, it can result in delays and setbacks for everyone involved. Credentialing is also not a one-time process — professionals must undergo re-credentialing every two to three years. This beginner’s guide provides the fundamental knowledge required to understand this process, including the challenges and obstacles a professional might enco ..read more

Malware, ransomware, and phishing are serious threats to computer systems, with ransomware denying access to data and phishing using fake emails to spread malicious links. Healthcare organizations are particularly at risk due to the sensitive patient data they hold, and recent years have seen a sharp increase in cyber-attacks reported to the Office of Civil Rights (OCR). To combat these threats, HIPAA requires healthcare entities to implement security measures and provide employee training.  DoctorsManagement now offers specialized training to help staff recognize red flags and prevent at ..read more

I love talking about compliance, what it means to be compliant and all the ways to demonstrate “good-faith” efforts to paint a picture of a top-down culture. But no matter how much I speak and no matter how many podcasts I do or articles I write there are still those who refuse to get the message or opt to assume more risk than anyone should be willing to take on. There is no doubt that payors and their contracted bounty hunters are pushing the limits when it comes to the recoupment of monies paid to providers. There is no letting off the gas pedal since margins are so critical and all provide ..read more

In today’s rapidly evolving healthcare landscape, the importance of chronic care management (CCM) cannot be overstated. With an aging population and increasing prevalence of chronic conditions, such as diabetes, hypertension, and heart disease, effective management of these conditions is essential for improving patient outcomes and reducing healthcare costs. Traditionally, medical practices have often turned to third-party providers to handle CCM services. However, there is a growing trend towards bringing these services in-house, and for good reason. Let us explore why performing chronic care ..read more

Medical practices today face a multifaceted challenge — providing exceptional patient care and ensuring compliance with complex regulations. As a healthcare professional, you’ve dedicated your life to healing, but there’s another facet of your practice that requires equal attention — medical audit reviews by the payor. These meticulous examinations by payors, like insurance companies or government health programs, audit physician documentation and coding to ensure accurate billing, compliance with regulations, and prevention of fraud. By reviewing documentation, they verify that serv ..read more

Establishing your own medical practice is a venture not many physicians choose, but for those who do, it is a commitment to healthcare excellence and an investment in your own financial success. However, before opening the doors to patients, there is a crucial preliminary step often overlooked: the feasibility study. In the complex landscape of healthcare, where success hinges not just on clinical prowess but also on economic viability and strategic planning, conducting a comprehensive feasibility study is paramount. Let’s examine why this preliminary analysis is indispensable before starting ..read more

The healthcare industry can be complex, demanding high accuracy and compliance standards. Health providers must offer quality patient care and maintain operational efficiency and financial integrity. Meeting these requirements requires precise information, meticulous record-keeping, and adherence to stringent regulations. The practice of medical auditing lies at the heart of this commitment to accuracy. How does medical auditing work? What does a medical auditor do? This article is your comprehensive guide to healthcare auditors. Learn what their responsibilities are a ..read more

Reviewing documentation and selecting codes for fracture care is not always as straightforward as it may seem. Often when I am working with clients, I find that information related to office-based fracture care is at times omitted and left up to assumption mostly based on the diagnosis code(s) the patient has. It is important for us to understand not only the CPT code descriptions but also what is expected from a documentation perspective to back up medical necessity and the care that is being rendered.  To code for fracture care, we must analyze the documentation to determine what the de ..read more

Managed care contracts serve as vital agreements between healthcare providers and managed care organizations (MCOs), outlining terms and conditions for services rendered. These contracts dictate reimbursement rates, service coverage, and performance metrics, playing a pivotal role in the financial sustainability and operational efficiency of healthcare organizations. However, as healthcare landscapes evolve, renegotiating these contracts becomes imperative for organizations to adapt to changing market dynamics, address inefficiencies, and optimize reimbursement structures. Therefore, the purpo ..read more