Audit Strategies For Oig Compliance

By Author: Angela Martin
Total Articles: 206
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Like any other healthcare provider, you probably have recurring nightmares about the OIG knocking at your door. But if you use certain audit strategies for OIG compliance, you can come out clean. Depending on what type of facility or physician office you work in, your audit strategies may vary. For some specialties and types of facilities, the OIG has specific concerns.

There are, however, many audit strategies for OIG compliance that all types of providers can use to their advantage.

Eye Care Services Are on the OIG's Hit List

Audit strategies for OIG compliance that some providers are using in terms of eye care services include:

Shoring up medical necessity and documentation strategies to secure claims in the event of an OIG audit;
Knowing exactly what you need with your E/M codes and how eye code requirements are entirely different;
Understanding how to keep your E/M versus eye code ratios on target; and
Nailing down reporting best ...
... practices to understand what E/M and eye codes should look like.

Secure Your OIG Compliance By Nailing Down Modifiers 25 and 59


Modifiers 25 and 59are notoriously misused -- and the OIG is cracking down on these mistakes now more than ever. Include in your audit strategies for OIG compliance a clear understanding of how to use these two modifiers.


Instead of being afraid of using modifiers 25 and 59 -- and losing out on deserved reimbursement by failing to use them where appropriate -- you must take the time to learn the right way to append them. A quick-reference sheet can come in handy, and heed the OIG's own recommendations on how to use modifiers 25 and 59.


How to Survive an OIG Audit


One of the most important audit strategies for OIG compliance is preparation. You must understand how to handle an unannounced onsite audit and how to respond to a chart review. Comprehending the OIG Work Plan is also key to designing coding and reimbursement processes that keep your healthcare organization compliant and profitable.


If you don't already have one, you should develop an effective auditing and monitoring program for your medical practice. This internal program will not only lock in your compliance, but it can also increase your revenue and improve your quality of care. Most of all, an auditing and monitoring program will fully prepare you for an OIG audit.