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The Physician’s Compliance Guide brings 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 identifies 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. An 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 workflow processes that are contributing to compliance errors and omissions. Identifying faulty processes is the first step 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.
