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Physician's Compliance Guide

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Publisher: Ingenix

Experts: Deborah Hall

Latest Edition: 2011

Sample Pages: View PDF

Purchase Options

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2011 Softbound

Dec 2010

$169.95

2010 Softbound

IN STOCK

$169.95

Strategies for OIG, RAC and MAC compliance

The Medicare program is stepping up efforts to reduce losses due to improper billing and coding practices. The new administration has indicated that Medicare overpayments, abuse, and fraud are areas that will be under increased scrutiny.

This new publication from Ingenix was created to bring physicians and practice managers up to speed quickly on federal investigative efforts that affect their organizations. With a focus on the top compliance risks for physician practices stemming from OIG, RAC, CERT and other contractor reviews, this resource will identify the range of investigative actions that can result in monetary recoveries or other penalties. Most importantly, it names key practice management issues that pose the greatest compliance threats and demonstrates how to efficiently comply with Medicare’s rules. Our analysis of each issue includes discussion of the root cause of the problem, and how to restructure work processes to boost compliance.

Features and benefits

Understand what the investigators (RACs, OIG, MACs) are looking for. Provides case studies and easy-to-understand examples of errors and non-compliance.
Identifies the agency or contractor conducting the investigation or review initiative. Know the reasons why the agency has an interest in this compliance area.
Area of investigation as outlined by the agency performing the review. Explains the official purpose of the review and how it fits with other current or earlier investigations.
Explanation of the infractions or errors. Shows which billing or coding practices are contributing to the error. Includes a discussion of what the agency is expecting to find, such as coding errors, inappropriate business relations, Stark violations, and balance billing violations.
Strategies for assessing risk. Gives physician practices the techniques, formulas and benchmarks to determine their risk and estimate potential liability.
Get guidance on identifying the work flow processes that are contributing to compliance errors and omissions. Identifying faulty processes is the first in protecting your practice.
Implement corrective actions to mitigate risk. Learn how to reduce or eliminate problems by establishing coding policies, educating staff, reviewing billing policies, or seeking legal assistance in renegotiating contracts and other business relationships.
Stay up-to-date throughout the year. Receive quarterly summaries of events and changes to Medicare’s compliance initiatives. Any reports, advisories or other notices that are released by the OIG, GAO, or contractors will also be included in these updates.