tci Medicare Compliance & Reimbursement - 2013 Issue 24
Risk Management: Don't Become an OIG Target
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Article Overview
This article covers broad risk-management and compliance review topics for medical practices, with emphasis on identifying operational areas that may attract scrutiny from federal and state healthcare programs and private payers. It discusses annual practice self-assessment, documentation and billing review themes, compliance planning, and use of government oversight resources. The content is geared toward practice owners, managers, compliance personnel, and coding or billing professionals who support internal audit and risk reduction efforts.
Why This Topic Matters
Healthcare practices face ongoing audit and compliance pressure, so a structured internal review can help identify weak points before they become enforcement issues. The article is relevant for organizations trying to improve compliance processes, documentation quality, and overall practice management.
Article Sections
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Identify practice risk areas
Introduces the need to review practice operations for compliance and business-risk concerns. Frames the article around areas that may attract scrutiny from oversight programs and payers.
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Give Your Practice a Check-Up
Focuses on annual self-assessment of the practice, including business planning, operational review, personnel screening, and general documentation and front-office evaluation.
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Keep Your Backyard Safe
Covers internal compliance monitoring topics such as problem areas, denials, documentation quality, utilization patterns, paper forms, and review of oversight resources and reports.
What You Will Learn
- How a practice-wide risk review can support compliance efforts
- Which broad operational areas are commonly assessed during an annual practice evaluation
- Why documentation, utilization, and internal processes are important in a risk analysis
- What kinds of oversight and reference resources may inform a compliance review
Who Should Read This
- Medical practice owners
- Practice managers
- Compliance officers
- Billing and coding professionals
- Healthcare administrators
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