title: Why should your practice perform compliance audits based on the latest OIG Work Plan?
abstract: Why have compliance audits, or medical record reviews, become an essential part of many progressive medical facilities? Because medical record reviews are known to improve reimbursement, documentation, and internally identify compliance issues that should to be promptly addressed, in order to protect the organization from substantial monetary penalties and legal sanctions by the federal government. This article discusses the importance of auditing based on the areas of focus recently identified in the OIG Work Plan. These include VA physician billing, pathology/clinical laboratory services, identifying referring physicians in Oklahoma that are sanctioned, high level E/M services, consultations, and red flags that are raised due to overuse of modifier -25 and -59.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hammon
mesh_terms: D005251:Fees, Medical; D005375:Financial Audit; D005607:Fraud; D019983:Guideline Adherence; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008485:Medical Audit / Q000191:economics; D006278:Medicare / Q000191:economics; D009825:Oklahoma; D011216:Practice Management, Medical; D013219:State Government; D014481:United States; D014493:United States Department of Veterans Affairs