BC Advantage - 2024 Issue 6

Crafting a Comprehensive Approach to Billing Compliance

The convergence of internal and external market dynamics presents a golden opportunity for healthcare finance leaders to reassess their billing and compliance procedures. Externally, both federal and commercial payors are intensifying audits and scrutinizing pre-payment claims, delaying cash flow, increasing the risk of penalties and clawbacks, and jeopardizing the financial bottom line of healthcare organizations nationwide.?    In its? 2023 Semi-Annual Report to Congress , the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) identified $200.1 million in expected audit recoveries and $277.2 million in questioned costs between October 2022 and...

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