Q&A: New Guideline and Regulatory Changes

Thanks so much to all of you who tuned in to our recent webinar, Simple Audit Solutions for Juggling New Guideline and Regulatory Changes. As promised, we’ve answered some of your most pertinent questions and are sharing them with all of our attendees because we value each and every one of you and want to support your thirst for knowledge. We are proud to boast a community of auditors and compliance experts like yourselves who endlessly seek to stay up-to-date and on top of your game.

New Guideline and Regulatory Changes Q&A

Q1: How would you compare APP billing data when they work in a specialist office? Since it's against their peers, not all peers work in the same specialty. Would it be more accurate to compare to physician billing data of that specialty?

A1: Tracking is completed by NPI number.

Q2: Could you please provide the link/resource and excerpt where the OIG recommends "external" audits vs "internal?”

A2: Either, not versus. I would recommend both. If the OIG mandates a compliance plan, the auditors will be external.

Q3: Health Plan: How many claims department audit should be audit per month?

A3: I recommend moving at the speed of trust, as once said by CMS

Q4: How often should you review HIPAA violations? Monthly, quarterly, yearly?

A4: Not sure the context, however, each violation should be reviewed.

Q5: Where can you find the bell curve for E/M codes assigned (locally or nationally) by specialty?

A5: I would check Leapfrog. You can create this with data found on the CMS website.

Thanks again to all of you who asked questions. If you didn’t get a chance to ask a question but you’d like to, simply put it in the comments below.