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What will auditors find if your claims or documentation were to be audited?  What would be the results be if you were investigated?

Blue Cross, Aetna and Medicare have increased audits. Recovery Audit Contractors are paid 24% commission to search through your records and recover funds for Medicare. What will you do when they audit you?

Recent Articles

What The FBI and Federal Prosecutors Say About Compliance

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | October 2, 2019 |

In July of 2019, Jim was one of 50 compliance officers chosen from over 500 applicants from around the nation to be selected to participated in a two day Compliance Symposium sponsored by the FBI and the Society of Corporate Compliance and Ethics.  The symposium was held at the FBI Headquarters in Washington D.C. and…

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Why Compliance Is Important

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | October 1, 2019 |

Compliance is required in health care and other industries. Based on information gathered, the OIG in 2018, determined that 41% of all chiropractic claims had errors or were deemed fraudulent.  It is for these reasons the OIG has targeted the chiropractic field and has made it part of their work plan each year since.  Many…

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Elements Of An OIG Compliance Program

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | September 30, 2019 |

Any doctor or entity receiving reimbursement from a federally funded health care program such as Medicare, Medicaid, Tri-Care, etc. is required to have compliance program based on Seven (7) Elements as described in the Federal Sentencing Guidelines. The 7 Elements are; Assign a designated Compliance Officer. Have open lines of communication to the Compliance Officer.…

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HIPAA Compliance Program Requirements

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | September 29, 2019 |

The Office of Civil Rights requires entities to have a properly developed HIPAA Compliance Program which is focused on protecting the privacy of patients and their Protected Healthcare Information.  Some of the requirements of a HIPAA Compliance Program are; Designate the following Compliance Officers Privacy Security Complaint Compliance Conduct a Security Risk Analysis of practice…

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Credentialing alone doesn’t guarantee compliance expertise

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | September 3, 2019 |

To be OIG and HIPAA compliant it is more than just purchasing a manual or having a consultant come to the office to conduct a compliance or chart audit.  In this article published in ChiroEconomics, we discuss the importance of selecting a certified and knowledgeable compliance consultant. The consultant should assist you in making your practice…

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What to do when the law knocks on your door about HIPAA compliance.

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | September 3, 2019 |

Facing the Men in Black What would you do if you saw “men in black” identifying themselves as FBI agents standing in the middle of your waiting room? Panic? Freak out? Faint? Many doctors think they are “flying under the radar,” but the truth may surprise you! Check out this article published in Chiropractic Economics.…

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False Claims Act Fine Print

By Diane M. Barton, DC, MCS-P, CIC & James Minx MCSP, CIC | September 3, 2019 |

You can be ‘Honest Abe’ and still fall short of the ‘Lincoln Law’ Do you realize what you are attesting to when you submit a claim?  Box 31 of the 1500 claim form reads: “Signature of physician or supplier including degrees or credentials (I certify that the statements on the reverse apply to the bill…

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SERVICES PORTFOLIO

We offer complete solutions & specialized programs

Complete Office Compliance Audits

Complete Physical Office Audit inspecting for Medicare/OIG, HIPAA, OSHA, NCQA, CLIA and ADA requirements and guideline compliance.

Patient File Review Audits

Charts are audited for proper documentation requirements, billing, coding, and medical necessity of services.

TRAINING Assistance

 conduct training for your office staff and employees on a variety of topics including Medicare/OIG and HIPAA compliance as well as billing, coding, and documentation. 

Compliance Officer Services

 We will help guide you and oversee your compliance efforts to ensure that you are compliant in the requirements and guidelines.

Having an ongoing effective compliance program is one of the only factors that can help you and your practice if you are ever investigated.