Demystifying the 2024 OIG Audit Selection Criteria
In today's webinar, we will delve into the essential regulatory bodies that play a pivotal role in ensuring healthcare compliance. We'll break down the intricacies of audits and investigations, offering insights into the various routes they can take. We'll also examine the OIG's 2024 work plan, shedding light on the key areas of focus, and spotlight emerging audit trends and potential audit targets for the year ahead. Additionally, we'll pinpoint actionable protocols for addressing compliance issues, dissect recent advisory opinions from the OIG, outline the fundamental components of a robust compliance plan, and provide valuable best practices to thrive in 2024. Register, https://conferencepanel.com/conference/navigating-the-2024-oig-audit-targets
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Demystifying the 2024 OIG Audit Selection Criteria
- 1. Navigating the 2024 OIG Audit Targets PRESENTED BY TONI ELHOMS, CCS, CPC, CPMA, CRC, AHIMA-APPROVED ICD-10-CM / PCS TRAINER 1
- 2. Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA Approved ICD-10-CM/PCS Trainer ❑ CEO – Alpha Coding Experts ❑ Podcast Host – Alpha Coding Podcast ❑ National Speaker - Coding, Compliance and Reimbursement SME ❑ Former President of Orlando, Florida AAPC Chapter ❑ Expert Witness ❑ Published Author ❑ Consultant/Educator/Trainer 2
- 3. Agenda Deconstruct Proactive vs. Reactive Compliance Approaches Discuss the role of the OIG Work Plan Spotlight 2024 OIG Audit Targets in healthcare compliance Discuss recent DOJ/OIG Press Releases Identify key elements of an effective compliance plan based on the OIG framework Q&A at the end 3
- 4. OIG Audit Targets ❑ Healthcare compliance audits and investigations are occurring at unprecedented rates ❑ Gone are the days when the large hospitals and pricey DRGs (diagnosis related groups) were the only targets on the radar for compliance enforcement ❑ Each year the OIG releases their respective work plan which highlights areas and services that represent high priority audit targets during the upcoming fiscal year with monthly updates 4
- 5. Governing Authorities CMS MACs State Medicaid Programs RACs ZPICs PSCs MICs UPICs OIG DOJ 5
- 6. OIG Audit Targets ❑ Telehealth and Telemedicine ❑ Behavioral Health ❑ COVID-19 ❑ Testing ❑ Labs ❑ Add-On Payments ❑ Vaccines ❑ Evaluations ❑ Chronic Care Management Programs ❑ Remote Patient Monitoring Programs 6
- 7. OIG Audit Targets ❑ E/M Services ❑ Incident-To ❑ Split-Shared Services ❑ Upcoding ❑ Unbundling ❑ Modifier 25 ❑ Modifier 59 ❑ Spinal Pain Management ❑ Physical & Occupational Therapy 7
- 8. Best Practice Tips ❑ Checks & Balances System ❑ Use Templates with caution ❑ Service requirements met ❑ Provider signature requirements met ❑ Copy/Forward edited for current presentation and encounter ❑ Act in Good Faith ❑ Avoid the Medically Unbelievable Day ❑ Demonstrate a culture of compliance 8
- 9. Oversight Audits: ❑ Internal ❑ External Frequency: ❑ Monthly ❑ Quarterly Image: thatchertech.com 9
- 10. Resources ❑ Centers for Medicare and Medicaid Services (CMS) ❑ Department of Justice ❑ Humana ❑ OIG Work Plan ❑ https://oig.hhs.gov/reports-and-publications/workplan/index.asp ❑ https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp ❑ OIG Advisory Opinions ❑ https://oig.hhs.gov/compliance/advisory-opinions/browse/ 10
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- 12. Register Now 12