With the slowing of COVID-19 cases in many parts of the country, CMS and the OIG are getting back to auditing high risk areas of regulatory compliance. The OIG is currently conducting a series of hospital compliance audits using computer matching, data mining, and data analysis techniques to identify hospital claims that are at risk for noncompliance with Medicare billing requirements. In a recently conducted audit, they have identified several areas of high risk which  we have summarized in the infographic below: 

We recommend conducting internal auditing and monitoring of your hospital coding and billing departments, specifically targeting these high risk areas identified by the OIG, to validate compliance with the Medicare billing requirements.  

You can read the full OIG report here: https://oig.hhs.gov/oas/reports/region2/21801018.pdf HBE’s team of coding and compliance experts is available to assist you with external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff.  We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.  

DISCLAIMER:  This newsletter contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel