The government may not have money to operate but that doesn’t mean theaudits will stop.  Even worst, while today may be a Federal Holiday most of us are working like if it was any other date so I’m getting my usual stream of reports and settlements based on audit activity.  So if I’m going to highlight these occurrences based on this morning’s data I will simple cover this: 1. Meaningful Use audits to Providers continue.  The sad part of that most small offices are not even aware of this actions or of the implications of the same.  Some are not even aware of how they will fare in an audit as they think they are in compliance.  Regretfully THIS IS NOT TRUE.  The fact that you submitted your attestation for meaningful use and that you got paid does not meant you are in compliance with the rules. 2.  OIG audits.  Pretty much the same as with the meaningful use, getting paid doesn’t mean you are in compliance.   In this case the lucky covered entity was the University of Wisconsin which supposedly owes $316,000 in Medicare overpayments on claims between 2008 and 2010.      The audit found billing errors in 48 outpatient claims and 51 inpatient claims. The OIG’s report attributes these errors to inadequate controls to safeguard against billing mistakes.   The review found multiple types of billing errors, such as patients being incorrectly billed as inpatient instead of outpatient or outpatient with observation services, incorrect discharge status and unreported manufacturer credits for replaced medical devices. Another audit last week found that the University of Miami Hospital overbilled Medicare by more than $3 million between 2009 and 2010.

My opinion and interpretation of this based on the available information is as follows:

1. Smaller offices are been hit with Meaningful Use audits as it is easy to prove non-compliance.  Quick-cash.
2. In case you didn’t notice, the OIG is going back a couple of years. So the easy pickings are over and they will now go deeper and more extensive.

As with all “settlements” the OIG recommended the hospital “strengthen controls to ensure full compliance with Medicare requirements.”  So if I was a hospital I will consider using a third party to review my compliance programs and coding.  Maybe even hire certified coders in house and have a third party doing spot checks as with medical records and risk management.

We do offer these services thru either our own resources or associates and partners which we recommend depending on the particular client’s needs.  So, there is no excuse, contact us today and be proactive in your defense.