Navigating the 2024 OIG Audit Landscape

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Navigating the 2024 OIG Audit Targets

• Presented By
• Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA-Approved
  ICD-10-CM / PCS Trainer

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Toni Elhoms, CCS, CPC, CPMA, CRC, AHIMA Approved
ICD-10-CM/PCS Trainer

• CEO Alpha Coding Experts
• Podcast Host Alpha Coding Podcast
• National Speaker - Coding, Compliance and
  Reimbursement SME
• Former President of Orlando, Florida AAPC
  Chapter
• Expert Witness
• Published Author
• Consultant/Educator/Trainer

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Agenda
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OIG Audit Targets

• 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 with monthly updates

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Governing Authorities
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OIG Audit Targets

• Telehealth and Telemedicine
• Behavioral Health
• COVID-19
• Testing
• Labs
• Add-On Payments
• Vaccines
• Evaluations
• Chronic Care Management Programs
• Remote Patient Monitoring Programs

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OIG Audit Targets

• E/M Services
• Incident-To
• Split-Shared Services
• Upcoding
• Unbundling
• Modifier 25
• Modifier 59
• Spinal Pain Management
• Physical Occupational Therapy

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Best Practice Tips

• Checks Balances System
• Use Templates with caution
• Service requirements met
• Provider signature requirements met
• Copy/Forward edited for current presentation and
  encounter
• Act in Good Faith
• Avoid the Medically Unbelievable Day
• Demonstrate a culture of compliance

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Oversight

• Audits
• Internal
• External
• Frequency
• Monthly
• Quarterly

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Resources

• Centers for Medicare and Medicaid Services (CMS)
• Department of Justice
• Humana
• OIG Work Plan
• https//oig.hhs.gov/reports-and-publications/workp
  lan/index.asp
• https//oig.hhs.gov/reports-and-publications/workp
  lan/active-item-table.asp
• OIG Advisory Opinions
• https//oig.hhs.gov/compliance/advisory-opinions/b
  rowse/

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