The Patient’s Story To someone on the street, a claim form may just look like a bunch of numbers. However, for medical professionals and, more importantly, insurance payers, it tells a story about the patient. As payers and coding authorities evaluate procedure codes, diagnoses, and reimbursement yearly, they are often looking for fraudulent behavior among…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.
Is your practice on the right track? Some clinics base their coding success on paid claims only to find themselves in a full audit that includes a take-back request from the insurance company dating back over two years in paid claims. This is a risky approach and can sink a practice. Investing time in self-audits…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.
How Often Should We Audit? A documentation audit should be completed once a year. It should include five charts per provider. If your initial audit findings show a high error rate, then you will want to follow the suggested follow-up audit schedule listed below. NOTE: In addition to a full documentation audit, we highly recommend…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.
Enforcing Standards The OIG General Compliance Program Guidance states, “Small entities should be prepared to designate someone, whether it is the compliance contact, an entity leader, or another designated employee, to determine whether a violation exists and the steps necessary to correct any problems. As appropriate, such steps could include: a corrective action plan; the…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.
Meet the Minimum on Each Encounter Most states have a minimum documentation requirement for licensed physicians and guidance from the licensing board. Some states’ regulations include chiropractic-specific details. Often, providers forget the Routine Office Visit (ROV) within “episodic care” must have a minimum set of targeted “updated” (comparative) subjective data components from the previous visit,…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.
The purpose of formal re-evaluation during an episode of care is to document changes to that point and to determine whether more active treatment is necessary. The frequency of these re-evaluations is at the doctor’s discretion and can vary based on the patient’s condition. The audit process will help you take a closer look at…
Oops, your level of membership doesn’t include access to these advanced materials. They are reserved for members working directly with our OIG compliance specialists. Please reach out to the HelpDesk to learn more about accessing these materials.
Click here to learn more.