Compliance Program Effectiveness: Auditing and Monitoring

What is one of the seven critical elements of the compliance program according to the OIG?

Ongoing auditing and monitoring

Disregard all policies mandated by OIG

Optional training and education of staff

Audit only incorrect claims

What is a condition of enrollement if a provider wants to participate with Medicare, Medicaid or Children's Health Insurance

Have a minumum of 25 providers

Compliance Program

Provider care for Medicare, Medicaid patients

Bill the patient directly

What is the recommeded least number of audits within a year?

According to Pam, an internal auditor should be used becuase the auditor already knows the provider's documentation.

True

False

Monotoring is an __________ ______________ control within a process

effective detective

defective detective

detection detective

offensive detection

How to measure accessibility of recording system?

Ignoring any surveys

Involving employees and managers and asking if system is available in languages spoke in organization.

Making up data

Ask only employees if they understand the system

Which is NOT a way to measure the Adherence to the 60-day overpayment rule

Review incident tracker

Ensure days to open or days to close do not exceed that timeframe

Status benchmarks specific day to completion.

Track efforts to identify

Allow payment to be late

Benefits of Independent Monitoring

Expensive, Time-Saving, Objectivity

Time-Saving, Cost-Effective, Objectivity

Time-Consuming, Cheap, Biased

Time-Saving, Cost-Effective, Subjectivity

What and when does the OIG provide that gives practices a heads up?

Money, May

Rules, December

Updates, January

Guidelines, September

What is one of the biggest challeges in health care?

Chart Audits

Not enough providers

Insurance Fraud

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