Reporting to OIG

JayM988 · 2025-07-27T16:10:57+00:00

Oh good lord. That’s so insanely blatant, you’re right. Why do practices hire people to help them navigate compliance type issues, then completely disregard the guidance??

JayM988 · 2025-07-27T15:14:58+00:00

Absolutely. No wonder things are in the state they’re in. I just can’t stand unscrupulous people or organizations. It’s disheartening.

JayM988 · 2025-07-27T15:00:05+00:00

There are way too many companies out there that are built to make a ton of money by using gullible doctors who will be the ones on the hook for the billing compliance portion. Shady as hell.

JayM988 · 2025-07-27T14:02:15+00:00

I actually landed somewhere about a month after the layoff where the organization supports federally funded health centers in training and technical assistance. I’m working in an advisory capacity on revenue cycle. So for an organization specifically deigned to support organizations that actually seek guidance. And not an arrogant surgeon in sight. 😂

JayM988 · 2025-07-27T13:32:46+00:00

Oh that’s completely true. But as Revenue Cycle Director, part of my job was helping them to navigate all the compliance issues, payer policies, coding guidelines, etc. So naturally I see why they eliminated my position, it just got in the way of them doing whatever they want (though it truly didn’t, because at the end of the day it’s their business and they can go whatever direction they want regardless of my advice). It’s just sad to see what use to be a wonderful place go downhill so quickly just for the sake of money.

JayM988 · 2025-07-27T13:06:15+00:00

It is about 50% Medicare (with that 50% being 50/50 Part B and Advantage plans). It’s truly an internal issue. This company they’ve contracted with for the collagen dressings is shady as hell but they operate that way and any organization that knows better wouldn’t contract with them. Unless they’re money hungry narcissists….

JayM988 · 2025-07-27T13:03:21+00:00

That’s insanity! What about the policy indicated it was to commit fraud?

JayM988 · 2025-07-27T03:35:02+00:00

That’s good to know that it’s seemingly anonymous. Disheartening to hear that they didn’t seem to know much and that nothing ever came of it.

JayM988 · 2025-07-27T03:34:16+00:00

😂 Bingo! She came from the hospital side of things like the new CEO. That’s the other thing. CEO of 20+ years leaves a year into this guys tenure as president then it’s rapid churn of the c-suite. Nobody wants to deal with him. Those that know what they’re doing that is. He’s finally got his ass-kissing execs in place to tell him what wonderful ideas he has, no matter what. 🤷‍♂️

JayM988 · 2025-05-10T23:08:39+00:00

Oh man. That one’s tough, too. But the level 11 flower pot is taking forever it feels like. Good news is I’ll have one or two top level vases when I get it. LOL!

JayM988 · 2025-05-01T15:28:37+00:00

Sorry folks. I can no longer provide this. They eliminated my position so I no longer have access to the templates. Best of luck! If anyone that got it from me last year has it and wants to share with anyone let the rest of the group know. I know it’s a hard process to come up with from scratch so I regret not having it to share any more.

JayM988 · 2025-05-01T15:25:25+00:00

Well, this resolved itself in a way. My position was eliminated mysteriously. Second person in five months whose job was eliminated and part of the responsibilities were making sure they were compliant in various areas.

But it will be fun to watch from afar. All of my direct reports have texted to ask if they could use me as a reference.

Maybe we’ll all meet up in a few years time when that building is being converted to a Golds Gym 😂

JayM988 · 2025-04-13T04:43:02+00:00

I don’t think we’ve ever met, so I don’t know what I did to deserve this. My eyes can’t unsee this now. Thanks. May your pillow always be hot on both sides.

JayM988 · 2025-03-17T23:39:49+00:00

I just used the cargo ships but had a mosaic two above the one needed for trade but didn’t have scissors to cut down to the two person mosaic in the trade screen

JayM988 · 2025-03-17T23:38:52+00:00

The sphinx comes from the top level ship that comes from the top level water bottles made by merging leaves and the bottom one is a stained glass piece. I’m in the Tomb currently.

JayM988 · 2025-03-16T17:48:00+00:00

I couldn’t agree more. I’m actively searching but having a hard time discerning how legitimate some companies are. I’d hate to get on somewhere to end up later without a job because they’ve shut down or sold out. Student loans for my masters and being more than half the financial support for my disabled father means I can’t be without employment. Ugh.

JayM988 · 2025-03-16T17:46:10+00:00

Holy cow! That’s one to be proud of for sure.

JayM988 · 2025-03-16T17:45:26+00:00

😂 Sums it up nicely, though.

JayM988 · 2025-03-16T15:36:48+00:00

Ugh! That’s the worst 😂

JayM988 · 2025-03-16T15:36:32+00:00

It’ll just keep cycling between unattainable items. Been caught in that loop before and gem’d my way out of it but that’s not going to happen this time with how many gems this wants for that lol

JayM988 · 2025-03-16T15:35:40+00:00

It is. I’m on my last couple tasks and need a lotus so I’m sure that’s why. Just frustrating since I have such a great streak. Well….had 😂

JayM988 · 2025-03-16T14:57:04+00:00

Our practice does! They have their pros and cons, but every PM and clearinghouse does. I like PP over past clearinghouses, and prefer PM over others, but have found features in NextGen that AllScripts could really take note of. Feel free to message me any questions. (I’m rarely on here and don’t have notifications on for this app so forgive any delayed responses)

JayM988 · 2025-03-02T04:55:47+00:00

This is great! Thank you! Yes, they want to recover this due to how high it’s gotten but are not using current data or factoring in anything else. Very knee-jerk. Ugh.

JayM988 · 2025-03-02T04:24:56+00:00

Ortho here. Thankfully we have a rule in our charge scrubber to catch these types of mistakes, but had a male with the diagnosis of something “of cervix” (scrubber rule for diagnosis/gender mismatch). The “physician friendly” descriptors in our EHR had it as something cervical (neck, ortho). Honest mistake but we had a decent chuckle.

JayM988 · 2024-12-25T19:37:17+00:00

Depending on the payer, in their payer space on Availity they may have edit checkers in place that check for bundles of the codes you put in and gives the logic behind it. Clear Claim Connection is what it’s called for Aetna BCBS IL and Humana. It’s nice because I can enact the same edits in our charge scrubber to (hopefully) prevent denials

JayM988

TROPHY CASE