Sei sulla pagina 1di 14

Don’t Get Burned by OIG

Speaker: Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™

1
Learning Objectives

• Get to know what’s NEW at OIG and what that means foryou
• Get the inside scoop on targeted billing errors found byCMS
• Including critical care visits, incorrect hospital visit billing, ESRDcoding and more…
• Gain practical advice on how to discuss government compliance with your
providers
• Highlight helpful tools and resources to help ensure coding andbilling
compliance

2
What’s New at OIG

• Office of Inspector General (OIG)Mission:


• Toprotect the integrity of HHSprograms
• Health and welfare of beneficiaries served by thoseprograms
• Mission is carried out through nation-wide network of audits, investigations,
and inspections conducted by:
• Immediate Office of InspectorGeneral
• Office of Audit Services
• Office of Evaluation andInspections
• Office of Management andPolicy
• Office of Investigations
• Office of Counsel to theInspector General

3
4
What’s New at OIG, cont.

• OIG Work Plan no longer in a large document


• All items for review are on found on an active work plan page
• Updated monthly to identify and respond to emergent issues
• Previously updated only once or twice ayear

5
What’s New at OIG, cont.

• Projects listed in the Work Plan span the Department and include:
• Centers for Medicare & MedicaidServices
• Centers for Disease Control and Prevention
• National Institutes of Health
• Administration for Children andFamilies
• Administration on Community Living
• Office of the Secretary of Health & Human Services

6
What’s New at OIG, cont.

• OIG provides independent and objective oversight that promotes:


• Economy
• Efficiency
• Effectiveness
• OIG's program integrity and oversight activities adhere to professional
standards established by:
• Government Accountability Office
• Department of Justice
• Inspector General

7
What’s New at OIG, cont.

• OIG assesses relative risks in HHSprograms


• Audits and evaluations may be cancelled
• OIG considers projects to take based on:
• Mandatory requirements
• Requests made or concerns raised by
• Congress
• HHSmanagement
• Office of Management andBudget
• Top management and performance challenges facing HHS
• Work performed by other oversight organizations
• Management's actions to implement OIG recommendations fromprevious
reviews; and
• Potential for positive impact 8
What’s New at OIG, cont.

• OIG's work portfolio includes legal and


investigative activities
• Investigating Fraud, Waste and Abuse
• Facilitating Compliance
• Excluding offenders from participating

9
Watch Out for Inpatient Billing

Work plan agenda


• Assessing Inpatient Hospital Billing for Medicare Beneficiaries
• Added December 2018
• Office of Evaluation andInspections
• Problems with upcoded visits

https://www.supercoder.com/medical-coding-webinars/dont-get-burned-by-oig

10
Medicare Compliance & Reimbursement Newsletter

• Keep on top of Medicare rules andupdates


• ICD-10
• Stark
• OIG reports
• MACRA
• Managed Care contracting
• And much more…
• Stay out of the auditors’crosshairs
• Twice a month

11
43
Resources

• https://oig.hhs.gov/reports-and-publications/workplan/active-item-
table.asp
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNProducts/MLN-Publications.html
• https://oig.hhs.gov/about-oig/about-us/index.asp
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNProducts/Downloads/MedQtrlyComp-Newsletter-
MLN8893947.pdf
• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-
Network-MLN/MLNProducts/Downloads/MedQtrlyComp-Newsletter-
MLN5862089.pdf 44
https://www.supercoder.com/medical-coding-webinars/dont-get-burned-by-oig

45

Potrebbero piacerti anche