The Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) has decided not to produce an annual Work Plan anymore, but rather to publish a portfolio of each of their most considerable areas of focus. It’s no secret that a primary focus of the OIG is to prevent and provide guidance for the combat of healthcare fraud, waste and abuse. As has been the case for many years, chiropractic services and improper payments are found in the cross-hairs of the OIG. They estimate finding $257-$304 Million per year in over-payments to chiropractic providers. No wonder they are concerned! This educational hour will outline how to avoid these overpayments, what to watch within your daily practice, and how this portfolio outlines the steps to manage your risk.
Learning Objectives:
- Be able to identify the definitions of Fraud, Waste and Abuse and how they may show up in day-to-day practice
- Become aware of the source of overpayments, including not-medically necessary care, maintenance care, and active treatment
- Apply the guidance from the OIG to your state and carrier regulations since they are a resource to these groups
- Recognize insufficient documentation and incorrect coding before the billing takes place
- Implement the action steps recommended by the OIG to eliminate incorrect documentation, billing and coding practices to reduce compliance risk
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.