Fraud, Waste and Abuse (FWA) Karen Shifflett worked as a Federal investigator (Special Agent) for 24 years with the Department of Justice (DOJ) and Department of Defense (DOD); she retired 10 years ago. She is now working as a Provider Fraud Analyst with the Provider Fraud Team for the U.S. Postal Service, Office of Inspector
Protected Health Information (PHI) Security Protecting PHI is essential in today’s healthcare landscape. A Protected Health Information (PHI) breach is any situation where PHI is used or disclosed in a way that violates HIPAA regulations, compromising its privacy or security. Essentially, it’s unauthorized access, use, or disclosure of PHI that puts the information at risk. Types of PHI Breaches:
Overview For healthcare providers, accurate physician credentialing that verifies physicians have the necessary licensure, experience, policies, and practices to provide safe and effective care is crucial, as it safeguards patients and protects healthcare organizations legally and financially. When one of the largest non-profit healthcare systems in the country needed a streamlined process for onsite visits
Overview Transitioning from a medical setting to a new environment after hospitalization is a very vulnerable time for patients, and one that must be monitored closely to ensure successful overall treatment. The National Committee for Quality Assurance (NCQA) has developed the Transitions of Care (TRC) measure as part of their HEDIS® measure set to better track the timely continuity
KDJ Consultants had the privilege of assisting HealthTexas Provider Network (HealthTexas) in their commitment to improve the quality of care delivered to patients. Through a strategy of Clinical Transformation, HealthTexas began by measuring how well they deliver preventive services. Then they trained groups of physicians, nurses and administrators to be quality champions, and moved to
Traditional efforts to detect Adverse Events (“AEs”), events that result in patient harm, have focused on voluntary reporting and tracking of errors through incident reports or similar reporting. However, public health researchers have established that only 10 to 20 percent of such errors are ever reported and, of those, 90 to 95 percent cause no
After an inpatient hospitalization, appropriate and timely follow-up care is key to the overall successful treatment of patients. As this is vital to quality care, the National Committee for Quality Assurance (NCQA), has developed the Transitions of Care (TRC) measure as part of their HEDIS® measure set. The TRC measure focuses on the percentage of
November is National Diabetes Month, a time when communities across the country team up to bring attention to diabetes.
The Secret of Successful EMR Reviews At the end of the day, quality EMR reviews boil down to one thing, accurately depicting what happened in that hospital room, emergency center, or outpatient clinic. Whether you are trying to control costs upfront or manage claims on the backend, accurate and thorough EMR reviews are essential. For
HEDIS® is the common acronym for Healthcare Effectiveness Data and Information Set, and is one of the most widely used tools available to report on the effectiveness of healthcare practices and procedures.
