Kelly Simonelli

Understanding Chronic Care Management Compliance

Chronic Care Management (CCM) plays an important role in supporting patients with multiple chronic conditions by providing coordinated, ongoing care between visits. Since 2015, Medicare has recognized the value of this care by offering separate reimbursement for CCM services under the Physician Fee Schedule. However, with reimbursement opportunities also comes increased scrutiny. When documentation does not fully support the services provided, CCM programs can quickly become an audit target. Our latest whitepaper was developed to…

Sampling for Medical Chart Audits

In healthcare documentation audits, reviewing every single claim or record simply isn’t practical — yet reliable conclusions are still essential. That’s where audit sampling comes in. By thoughtfully selecting a subset of records to review, auditors can efficiently uncover insights and risks that reflect the broader population. Our whitepaper, Sampling for Medical Chart Audits, breaks down the most common sampling strategies and explains how choosing the right one impacts your results. What You’ll Learn From…

Improper Medicaid Payments for Rehabilitative and Community Support Services Identified in Newly Released HHS-OIG Audit Report

In a recent report published by the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), it was concluded that the Medicaid program in the state of Maine made improper fee-for-service payments of at least $45.6 million for rehabilitative and community support (RCS) services furnished to children diagnosed with autism spectrum disorder (ASD) that were found to out of compliance with Federal and State requirements. In the wake of these findings, HHS-OIG…