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OIG Compliance Program Guidance

The Compliance Program Guidance for Small Group Physician Practices from the OIG is a document designed to help physicians in solo or small group practices conduct effective voluntary compliance measures to prevent fraud and abuse in governmental health programs, including Medicare and Medicaid.

Compliance programs are vital to the physician practice because an effective compliance program can help physicians identify both erroneous and fraudulent claims and help ensure that submitted claims are true and accurate. This ensures that you are receiving accurate reimbursement.

The OIG encourages a step-by-step approach for following the Model Compliance Plan, this program will tell you the OIG priorities, including which compliance elements physicians should implement first.

The Medicare Contract

• What are your responsibilities?
• What are the fines and penalties?
• Is it necessary to have a Medicare patient's signature on file?

Fraud & Abuse

• Could waiving a patient's co-pay really be considered a "Rebate, Kickback or Bribe?"
• What does HIPAA (Health Insurance Portability and Accountability Act)and the Balanced Budget Act of 1997 have to do with Medicare Fraud and Abuse?

IF YOU DON'T KNOW THE ANSWERS TO THESE QUESTIONS, NOW IS THE TIME TO REGISTER FOR THE MEDICARE COMPLIANCE SEMINAR.

CPT & ICD-9-CM Coding

• Does medical transcription require the provider's signature?
• Incident to Billing for Nurse Practitioners, Physician Assistants - Are you sure you are doing it right?
• Are you showing medical necessity in your chart documentation?
• Do you know what key elements should be included in the documentation for a new or established patient?
• When can you bill for a Consultation? Is a new patient referral to the specialist always billed as a consult?
• Can a primary physician bill a consult on his/her own patient?
• Are you properly using modifiers?

HCFA's Correct Coding Policy for Medicare Part B Carriers

• Do you understand the terms "fragmenting" and "unbundling"?
• What about comprehensive/component and mutually exclusive codes?
• Do you know if using an add-on code reduces your reimbursement?

Medicare Covered vs. Non-Covered Services

• When do you need an ABN?
• Is it OK for the patient to sign after the service is provided?
• Is a "blanket" ABN acceptable?

THIS PROGRAM WILL SHOW YOU HOW HONEST MISTAKES MADE OVER AND OVER CAN PROVIDE THE CARRIER WITH A STATISTICAL PATTERN INDICATING A FRADULENT AND ABUSIVE SITUATION.

The Appeals Process

• How do you deal with denials and request a review or fair hearing?
• What do you do if there has been an overpayment?
• Can you wait until they ask for the money back?

Pre- and Post-Payment Audits By The Carrier

• Are you aware that Medicare is conducting pre as well as post-payment audits?
• Are you using the Medicare audit information for your benefit?