The session addresses a review of OIG Work Plan issues for hospitals, clinics and other health care providers with particular emphasis on coding, billing and reimbursement. FY2018 Work Plan issues are addressed in the context of OIG Work Plan issues from FY2013 through FY2017. Pertinent reports issued by the OIG are also discussed particularly in relation to established OIG issues. Reports issued by the OIG relative to fraud and abuse relative to coding and billing are reviewed.
Additionally, associated RAC issues are discussed relative to current and anticipated trends. Particular attention is given to identification of issues in the context of internal and external auditing to make certain that any OIG and RAC issues are adequately addressed by health care providers. For this workshop, the main concentration of issues will involve hospitals and facilities. Physician concerns involving hospitals will also be addressed.
- Just what are these OIG Work Plans?
- What kind of reports are issued relative to these Work Plan issues?
- Do hospitals and other healthcare providers need to be concerned?
- Why do these work plans get longer and more involved each year?
- Why is there such as emphasis on coding, billing and the false claims act?
- Are there any trends in issuance of the work plans over the past several years?
- What kinds of resources does the OIG have?
- How do the OIG studies fit into the RACs and other federal auditing entities?
- Does anyone pay any attention to these OIG reports and recommendations?
- Does CMS always follow the recommendations of the OIG?
- Over the years are there any emerging trends in the issues addressed by the OIG Work Plans?
- Where can I access these work plans and the reports that are issued relative to the identified issues.
- When is the OIG Work Plan supposed to be issued each year?
- Does the OIG issue rule changed through the Federal Register?
- To Understand The OIG Work Plan Process
- To Appreciate the Importance of the Various Reports Issued by the OIG
- To Review Issues for FY2018
- To Review Any Recent Reports Involving Fraud and Abuse
- To Understand the RAC Development and Approval of Issues
- To Identify OIG Trends For Issues and Their Relationship to RAC Issue Development
- To Identify Compliance Issues That Need To Be Addressed By Physicians, Hospitals, Facilities and Other Health Care Providers
- To Identify And Review Various Reports Issued By The OIG Relative To Audits And Studies Performed As A Part Of The OIG’s Work Plans
- To Assess Which Issues Will Develop and Eventually Be Investigated by the RACs and Other Federal Auditors
- To Look for Trends Relative to the OIG Work Plan Issues
- Action Steps That Should Be Taken By Hospitals and Other Healthcare Providers
- Review The OIG Publications
1. Issuance of Work Plans
2. Issuant of Reports Relative to the Work Plans
3. Special Reports
4. Corporate Integrity Agreements (CIAs)
- Review The RAC Process
1. Development and Identification of Issues
2. Gaining Approval for Issues
- FY2018 OIG Issues
3. Other Types of Healthcare Facilities
4. Overlapping Issues with Physicians and Hospitals
- Review FY2013 Through FY2017 Work Plans
1. Trends in the Development of Work Plan Issues
2. Issues Repeatedly Appearing in the Work Plans
- Review Special Reports Issued by the OIG
1.Relationship To Published OIG Work Plan Issues
2. Outpatient Services to Inpatients at LTCH, IRFs, and IPFs
3. Cost Outliers
4. Three-Day Payment Window
5. Health Record Incentive Overpayments
6. Right Heart Catheterizations with Biopsies
7. Cochlear Implants Overpyments
- Associated RAC Audit Issues
1. Current Categories of Issues
2. OIG Issues Relative to RAC Audit Issues
3. Anticipated Issues for the Future
- Identification of Action Steps For Health Care Providers
1. Hospital Concerns
2. Utilizing the OIG Work Plan As A Guide for Compliance
3. Other Related Health Care Provider Concerns
- Review of Reports and Compliance Guidance Issued by the OIG
2. Clinics and Physicians
3. Other Health Care Providers
- Sources for Further Information
- Non-Physicians Practitioners
- Clinic Coding/Billing Personnel
- Compliance Personnel
- Chargemaster Coordinators
- Chief Financial Officers
- Billing and Claims Generation Personnel
- Financial Analysts
- Cost-Accounting Personnel
- Managed Care Contract Personnel
- Revenue Enhancement Personnel
- Revenue Cycle Specialists
- Internal Auditing Personnel
- All Other Hospital Personnel Interested in Compliance Issue
About The Speaker:
Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in health care and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews,coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.
In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.
Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.
Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding &Billing: A Guide to Reimbursement & Compliance published.
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