Moving into a new year there are so many areas health care organizations must focus on but how do you prioritize? The answer; it depends… The only way to understand where you’re most vulnerable is by performing a “Gap Analysis” to understand where you are versus where you should be. HIPAA has teeth and they’re sharp. Fines are stunning as are the Resolution Agreements organizations are being forced into. The OIG has not gotten any more aggressive; they just continue to do their job, ferreting out Fraud, Waste and Abuse and targeting those they believe data points to as outliers or having aberrant billing patterns. This session will focus at the 30,000 foot level on specific risk areas these 3-letter agencies are focusing on and steps health care organization should be taking to mitigate risks.
Learning Objectives – There are two (2)
1. OCR’s focus in 2021 and what needs to be performed to identify and mitigate risks
a. How to avoid the “Ding” focus on your BAAs, Risk Assessment, P&Ps and Staff Education
2. OIG’s focus in 2020 – 2021 – areas providers should concentrate to close gaps and demonstrate a culture of compliance (Good-Faith).
a. Evaluation and Management Services 2021 Traps
b. Incident-to and the continued quest to move providers away from this billing practice
c. Cloning and Clinical Plagiarism is on the rise
d. CBRs and How CMS and Private Payers use this tool to demand provider obedience