Medicare Compliance & Reimbursement - 2008 Issue 36
Compliance: OIG: You Can Hire A Contractor to Process Pre-Authorizations
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Article Overview
This article covers an OIG advisory opinion involving a contractor arrangement for handling insurance preauthorizations on behalf of radiology and imaging centers. It explains the compliance significance of the anti-kickback analysis, the general factors the OIG considered in evaluating the proposed structure, and why the arrangement was viewed differently than a potentially referral-influencing payment model. The piece is relevant to compliance staff, billing and revenue cycle professionals, administrators, and health care attorneys who monitor fraud-and-abuse risk in imaging and administrative outsourcing relationships.
Why This Topic Matters
Outsourcing administrative functions can create fraud-and-abuse concerns when payment structure or business relationships could be seen as influencing referrals. This article helps readers understand the compliance issues surrounding contractor-based preauthorization services and the broader role of OIG advisory opinions in evaluating proposed arrangements.
What You Will Learn
- How an OIG advisory opinion can evaluate a contractor arrangement in health care
- What compliance issues arise when administrative services are tied to preauthorization workflows
- Why payment structure and referral risk matter in fraud-and-abuse analysis
- How imaging and radiology businesses may think about outsourcing preauthorization tasks
- The general role of the anti-kickback statute in assessing proposed business arrangements
Who Should Read This
- Compliance officers
- Health care attorneys
- Radiology and imaging center administrators
- Revenue cycle and billing professionals
- Medical practice managers
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