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OIG Auditing and Monitoring Guidelines for 2023 – Navigating New Changes

Conference Materials (Password Required)

Based on the Affordable Care Act of 2010 any physicians that treat Medicare or Medicaid beneficiaries will be required to have a compliance plan. Many offices are non-compliant and either do not have a plan, or have a plan but are not following it. The Office of the Inspector General (OIG) created an outline of a compliance plan for group practices that any practice can use as an outline to build a compliance plan. While this is an outline, there currently are no requirements that this has to be followed, but it is the best practice since the OIG oversees compliance. We will review the 7 effective components of a compliance plan released by the OIG, and discuss how to create your plan using this information. After the completion of a plan, it must be followed and executed. A plan not followed is worse than not having a plan at all. The compliance plan is always adjustable as long as all who must follow it are aware of changes that are made, and it really can be set up to meet the needs of any practice. The current basics of auditing will also be discussed.

Learning Objective:
  • Understand the 7 components of a compliance plan
  • Realize what areas of your office should be included in the compliance plan
  • Build the compliance plan
  • Learn how to apply the plan, and follow the steps
  • Create compliance guidelines and goals that are obtainable
  • Know what training materials will work best
  • Confirm that the office understands the 2021 AMA E/M guidelines
Areas Covered in the Session:
  • OIG
  • CMS-CERT, RAC
  • Cigna
  • Humana
  • Worker’s Compensation
  • Affordable Care Act
  • OIG Compliance Plans
  • Plan Mandates
  • 7 Effective Components
  • Policies and Procedures
  • Purpose of Auditing
  • What to Audit
  • Medical Necessity
  • E/M Basics
  • History
  • Past, Family, Social, History
  • Expanded Problem Focused History
  • Detailed History
  • Comprehensive History
  • Examination
  • Expanded Problem Focused Exam
  • Detailed Examination
  • Novatis 1997 E/M Score sheet’s
  • Medical Decision Making
    • Diagnosis
    • Data
    • Risk
    • Treatment plan
    • Complexity of procedures/services needed
    • Risk of procedures/services needed
  • Coding By Time
  • Documentation Requirement
  • Low MDM
  • Moderate MDM
  • High MDM
  • Content of Counselling Summary
  • Clinic/Outpatient Visits
    • New Patient Visits
    • Established Patient Visits
    • Clinic Consultations
  • Hospital Inpatient Visits
    • Initial Hospital Care
    • Subsequent Hospital Care
    • Inpatient Consultations
  • Documentation
    • E/M
    • Diagnostic tests
    • Order (medical necessity)
    • Hard copy
    • Interpretation
    • Procedures
    • Other Services
    • Signature
  • Reporting Results
    • Document findings and keep as permanent records
    • Medical Records
    • Summary (see attachment)
    • Information shared with Provider(s)
    • Spreadsheet
  • Audit Summary
  • Post Audit Actions
    • Create protocol
    • Determine training means
    • Mandate Training
  • Provider Training
  • Follow Up
Suggested Attendees:
  • Healthcare Executives CEOs, COOs, CFOs,
  • Healthcare providers
  • Hospital and facility administration
  • Healthcare Policy Analysts
  • Healthcare Business Researchers
  • Legislative or Regulatory Advisors
  • Billers
  • Coders
  • Administrators
  • Managers
  • Supervisors
  • Physician
  • Non-Physician providers
  • Qualified Healthcare Professionals
  • Compliance officers
  • Consultants
  • Claims adjusters
  • Case Managers
Presenter Biography:

Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area. She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars. Lynn became a CPC in 1993, a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.


This is a Live Virtual session.

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TESTIMONIALS

“Jim Sheldon-Dean’s insights on privacy and security were very much helpful to our team, it was great to learn from an instructor like him. Appreciate!”
–CHRISTINE JACOB MD, CDI SPECIALIST

“This program on HIPAA did a great job providing actionable concepts in a way that updated our team and me, I now know how I will implement the concepts because I already did it in their online seminar, it was easy to ask questions from the speaker at the end of my 60 minutes course.”
–MELISSA PRESTON, HEALTH INFORMATION MANAGEMENT STAFF

“The workshop was very insightful and made absolute sense in terms of the regulations and their compliance. I am thankful for having the opportunity to attend.”
–BARBARA CAPRIOTTY, REHABILITATION DIRECTOR

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