Healthcare Compliance Audits & Investigations - 2023 Updates

Healthcare is a multi-trillion-dollar industry that remains highly regulated. When organizations bill for services, they are reimbursed on a good-faith basis with the expectation that clinical documentation supports the services reported and regulatory compliance has been met. Every year the OIG releases their respective work plan which highlights areas and services that represent high priority audit targets during the upcoming year. It is important to stay aware of these audit targets and use the work plan as a guide to mitigate compliance risk. Healthcare compliance audits and investigations are occurring at unprecedented rates. Gone are the days when the large hospitals and pricey DRGs (diagnosis related groups) were the only targets on the radar for compliance enforcement. Each year the OIG releases their respective work plan which highlights areas and services that represent high priority audit targets during the upcoming fiscal year. It is imperative for organizations to stay diligent and apprised of these compliance initiatives and be especially proactive in their compliance efforts, conduct regular audits of processes and clinical documentation, and comply with the mandatory self-reporting requirements set forth by the Affordable Care Act.

Webinar Objectives

This webinar will cover the key governing authorities involved in healthcare compliance, dissect various pathways involved in audits and investigations, review the OIG work plan, spotlight current audit trends and audit targets, identify relevant action protocols, discuss recent OIG advisory opinions, identify elements of an effective compliance plan, and discuss actionable best practice tips.

Webinar Agenda

• Understand the governing authorities involved in overseeing and enforcing healthcare compliance
• Recall the role of the OIG Work Plan
• Recognize current trends and OIG audit targets in healthcare compliance
• Recall overpayment and voluntary refund protocols
• Recognize when the OIG self-disclosure protocol may be appropriate
• Understand relevant and recent OIG Advisory Opinions

Webinar Highlights

• Outline the governing authorities involved in overseeing and enforcing healthcare compliance
• Review the various pathways involved in healthcare compliance audit and investigations
• Discuss the role of the OIG Work Plan
• Deconstruct current trends and OIG audit targets in healthcare compliance
• Discuss fee-for-service payment methodology audit targets
• Review risk-adjustment payment methodology audit targets
• Define the process of audit error rate extrapolation
• Identify key elements of an effective compliance plan based on the OIG framework
• Review the overpayment and voluntary refund protocols
• Discuss when the OIG self-disclosure protocol may be appropriate
• Review relevant and recent OIG Advisory Opinions 
• Discuss proactive compliance best practice tips

Who Should Attend

• Medical Coding Specialists
• Medical Billing Specialists
• Medical Auditing Specialists
• Private Practice Physicians
• Managed Care Professionals
• Operations Leadership
• Practice Administrators
• Office Managers
• Compliance Officers/Committees  
• American Academy of Professional Coders
• American Health Information Management Association
• Medical Group Management Association
• Health Care Compliance Association
• Medical Associations