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| THE PATHFINDER NEWSLETTER |
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Hello!
Welcome to the July 2008 issue of THE PATHFINDER.
DOCUMENTATION: Proof, Evidence; an original or official paper relied on as the basis, proof or support of something; a writing conveying information...
All of us are held accountable for documenting the services we provide patients and for the appropriateness of the subsequent billing. The stakes are high for everyone - agency and professional staff member - if we do not document correctly. Our first article this month discusses incomplete documentation and the risk of an accusation of false billing by governmental agencies like the Office of the Inspector General (OIG).
In reviewing submitted paperwork, what happens if you discover that a record in incomplete or inaccurate? Can you correct or supplement a record? Read our second article by Elizabeth Hogue to learn whether corrections and supplements to clinical records are appropriate and ethical.
Lastly, keeping with the theme this month, I have included an article by Richard Gray, written for HealthLeaders Media. I believe that this article is not only timely, but provides some guidance on what to monitor in your healthcare delivery process. With fraud control a top priority for the U.S. Department of Justice and as ethical healthcare leaders, all of us need to be vigilant in monitoring our agencies for compliance.
Elizabeth Hogue, Esq and I are planning a tele-seminar for Tuesday, July 29 at 1P Eastern entitled "Selling Your Hospital-Based Agency - Both Internally and Externally." This tele-seminar is specifically for hospital-based agencies, emphasizing some of the special issues that these agencies often confront. The tele-seminar is sponsored by Wyatt Matas and will be available at no cost to hospital-based agencies who request the call-in information. If you would like to attend the tele-seminar, e-mail your name, title, organization and e-mail address to bcarpenter@bethcarpenterandassociates.com. Call-in instructions will be sent prior to the tele-seminar.
I hope each and every one of you have the opportunity this month to enjoy a quiet summer evening watching a sunset, the opportunity to hear the laughter of children splashing in a pool and a ride in a convertible with the Beach Boys turned up loud!
If we can provide you with any assistance, please do not hesitate to contact us.
Best wishes, Beth Carpenter
“Let us realize that the privilege to work is a gift, that the power to work is a blessing, that the love of work is success.” David O. McKay |
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THE OLD ADAGE: IF IT IS NOT DOCUMENTED, IT WAS NOT DONE
By Elizabeth Hogue, Esq.
The old adage, "If it is not documented, it was not done;" is unfortunately often true. The consequences of failure to document may be severe in terms of allegations of fraud and abuse. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has repeatedly stated that providers carry the burden of proving that care was actually rendered to patients. If practitioners were unable to prove that they rendered appropriate care because it is not documented, the OIG and other fraud enforcers may conclude that claims submitted by these providers are false claims.
The consequences for submission of false claims are potentially severe. The amount of the false claims may, for example, be tripled and providers may be required to pay this amount. Millions of dollars and sometimes the ability of providers to continue their businesses may be at stake.
To read the entire article, please click here...The Old Adage. |
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ARE CORRECTIONS/SUPPLEMENTS TO CLINICAL RECORDS ILLEGAL OR UNETHICAL?
By Elizabeth Hogue, Esq.
Many providers are appropriately conducting a variety of retrospective reviews of patients' clinical records. These audits may reveal incomplete or inaccurate records. The records must be, therefore, corrected or supplemented, if possible, in order to help ensure quality of care, meet applicable regulatory requirements, and avoid allegations of fraud and abuse.
When managers ask clinicians to assist them with this process, however, some staff members still conclude that they are being asked to engage in illegal and/or unethical conduct. On the contrary: it is absolutely essential to correct and/or supplement records whenever it is appropriate to do so.
To read further, click here... |
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RED FLAGS FOR FRAUD
By Richard Gray
For HealthLeaders Media
May 5, 2008
The American College of Healthcare Executives Code of Ethics states that the healthcare executive shall, within the scope of his or her authority, "prevent fraud and abuse and aggressive accounting practices that may result in disputable financial reports."
But how can an executive even hope to detect this growing phenomenon, much less prevent it?
To learn more... |
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Beth Carpenter
Beth Carpenter and Associates 847-382-1035
bcarpenter@bethcarpenterandassociates.com
Beth Carpenter and Associates has earned a reputation as a company with deep industry experience and one that works closely with its clients to identify solutions that meet their business goals and strategic objectives. We do not simply advise. We partner with our customers to implement the solution and ensure its success.
Sincerely, Beth Carpenter |
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ARE YOU ON THE RIGHT PATH?
Since 1995 Beth Carpenter and Associates has provided its real-world experience to the management of healthcare companies, especially those organizations with a focus on home health, hospice and private duty, in the areas of operations, clinical services, sales and marketing. We work with management to identify the strategic direction of the organization and implement the necessary changes that allow health care providers to move forward in today's environment.
We help you choose the right path to success and then we walk it with you. |
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