Congratulations! You have reached the final step in understanding the core elements of OIG compliance. It is time to put together all the pieces to create a process that will fix what is broken. You must never let your compliance-related activities be verbal only. You need to keep documented proof of every investigation, report, and…

Reporting Overpayments CMS relies on the existing voluntary refund process defined in the Medicare Financial Management Manual, as well as claims adjustments, credit balances, and self-reported refunds to report and return overpayments. It is important to include the following information in your report: The health insurance claim number How the error was discovered Description of…

Alleged Non-Compliance One of the most common offenses in clinics is the mismanagement of overpayments. An overpayment is not a payer’s way of saying, ‘well done, you deserve a bonus.’ The same applies to patient overpayments – when the patient pays more than the patient portion assigned to the claim by the payer. All credit…

This tutorial will walk you through the steps of a compliant incident reporting process. The investigation process requires the clinic to ask questions, gather data and assess risk. This leads to documenting the offense, assigning corrective actions and implementing training.  Use this tutorial to assess your current process for incident reporting and take note of…

Do Not Ignore Offenses It is important that a clinic not only complete thorough audits but also prepare corrective actions if warranted. In some cases, the corrective action requires additional reporting to authorities and/or immediate legal action. An offense can be as simple as an employee not abiding by the code of conduct. And it…

Audits allow the compliance officer to keep a finger on the pulse when it comes to compliance activities. At this point of the OIG implementation training, you will learn about self-auditing by shadowing the KMC University Specialist as they use a variety of auditing tools. Guidance on the Auditing Process For you and the Specialist…