What is the Fraud and Abuse Control Program?

Questions asked:

Discuss some common causes for coding errors and the preventative measures you can use to avoid them.

2) What are some other measures you can add to the list that might not be in the course materials?

3) What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it’s major concern?

Halle Pietras Week 3 :

OIG stands for the office of inspector general, they are an oversite agency that works for the United States department of Health and Human Services (HHS.) There goal is to promote and protect our healthcare programs. That also means they look out for things like fraud and abuse when it comes everything, even coding and billing.

When it comes to coding there is a lot to remember, but there’s also a lot left up to assumptions which is where people can get into trouble. There’s also a lot of “gray area’s” according to our book, which leaves things open to different interpretations. Those are hard things to combat but some suggestions and or rules help to eliminate them the best they can. One mandate to remember is that coding MUST be supported by a health record. Another one to prevent fraud would be to use outside auditors to review the claims and make sure things check out. Other basic things would be to monitor and double check the claims, to make sure everything is the most correct you can make it. Make sure you understand what you’re doing and if not ask someone who could advise you.

Reference

Aalseth, P. (2015). Medical Coding: What Is it and How It Works (2nd ed.). Burlington, MA: Jones & Bartlett Learning

Post 2

Richard Matos Week 3 – Discussion forumCOLLAPSE

Richard Matos

Professor J. Pryor

CPT Coding for Health Services Administration

Coders generally make two types of errors when making coding decisions; Performance errors and Systematic errors. Performance errors include misreading words, missing important details to the code assignment, failing to pull together details from various parts of the record and transposing digits in code numbers. Systematic errors include lack of sufficient medical knowledge to understand the documentation, lack of knowledge of or misapplication of coding rules.

To avoid errors coding departments should verify the patient’s insurance benefits and personal information, double check diagnosis and procedures codes, write clearly and implement an EHR billing system.  Conducting charts audits are also a good way to avoid submitting claims twice.  Proper training, care and attention to details is the best policy to avoid coding errors. also, managers should implement policies and programs to help staff better understand the importance of avoiding errors.

The U.S. Department of Health and Human Services established a Fraud and Abuse Control Program, effective January 1, 1997, to fight health care fraud, waste, and abuse.  The Office of Inspector General (OIG) carries nationwide audits, investigations, and inspections in order to protect the integrity of the HHS.  The OIG also has the authority to investigate hospitals, pharmaceutical manufacturers, third-party billing companies, ambulance companies, physicians practices, nursing facilities, home health agencies, clinical laboratories, hospices and companies that supply durable medical equipment, prosthetics, and orthotics.  The OIG also works with the FBI and other federal agencies in the investigation of fraud and abuse.

WC-262

Reference

https://www.m-scribe.com/blog/bid/291707/5-Tips-to-Help-Your-Practice-Avoid-Medical-Billing-Errors

https://www.cms.gov/newsroom/fact-sheets/health-care-fraud-and-abuse-control-program-protects-consumers-and-taxpayers-combating-health-care-0