Physician's Compliance Guide

Please note: You may wish to make your selection according to publication date. However, keep in mind any book not yet published can be easily pre-ordered so that you can conveniently plan ahead. You may also be interested in the Hospital Compliance Desk Reference.

2011 Book
ISBN 1601513585
978-1601513588
Ingenix / HFMA
January 2011
(click below for the best available price for this 2011 book)

2012 Book
ISBN 1601515553
978-1601515551
Ingenix / HFMA
December 2011
(click below for the best available price for this 2012 resource)

Strategies for OIG, RAC and MAC compliance!

The Medicare program is stepping up efforts to reduce losses due to improper billing and coding practices. The new administration has indicated that Medicare overpayments, abuse, and fraud are areas that will be under increased scrutiny.

The Physicians’ Compliance Guide brings physicians and practice managers up-to-speed quickly on federal investigative efforts that affect their organizations.

With a focus on the top compliance risks for physician practices stemming from OIG, RAC, CERT, and other contractor reviews, this resource will identify the range of investigative actions that can result in monetary recoveries or other penalties.

Most importantly, it names key practice management issues that pose the greatest compliance threats and demonstrates how to efficiently comply with Medicare’s rules. An analysis of each issue includes discussion of the root cause of the problem, as well as how to restructure work processes to boost compliance. Features and benefits:

Understand what the investigators (RACs, OIG, MACs) are looking for. Provides case studies and easy-to-understand examples of errors and non-compliance.
Identifies the agency or contractor conducting the investigation or review initiative. Know the reasons why the agency has an interest in this compliance area.
Area of investigation as outlined by the agency performing the review. Explains the official purpose of the review and how it fits with other current or earlier investigations.
Explanation of the infractions or errors. Shows which billing or coding practices are contributing to the error. Includes a discussion of what the agency is expecting to find, such as coding errors, inappropriate business relations, Stark violations, and balance billing violations.
Strategies for assessing risk. Gives physician practices the techniques, formulas and benchmarks to determine their risk and estimate potential liability.
Get guidance on identifying the work flow processes that are contributing to compliance errors and omissions. Identifying faulty processes is the first in protecting your practice.
Implement corrective actions to mitigate risk. Learn how to reduce or eliminate problems by establishing coding policies, educating staff, reviewing billing policies, or seeking legal assistance in renegotiating contracts and other business relationships.
Stay up-to-date throughout the year. Receive quarterly summaries of events and changes to Medicare’s compliance initiatives. Any reports, advisories or other notices that are released by the OIG, GAO, or contractors will also be included in these updates.

View sample pages here from a previous edition.

The author, Deborah Hall, is a senior clinical/technical editor for Ingenix. Ms. Hall has more than 20 years of experience in the health care field. Her experience includes 10 years as office manager for large multi-specialty medical practices. Ms. Hall has written several multi-specialty newsletters and coding and reimbursement manuals, and served as a health care consultant. She has taught seminars on CPT®/HCPCS and ICD-9-CM coding and physician fee schedules. She is an active member of the American Academy of Professional Coders.

Ingenix offers practical results-oriented services for coding, physician documentation, billing compliance, reimbursement, training services for hospitals and physicians, and more. Learn from the experts who help write the books other consultants are using. Thousands of physicians and health care professionals rely on Ingenix for expert advice. Start benefiting from 100+ years of combined experience and expertise. CPT is a registered trademark of the American Medical Association.

Please remember that the government no longer allows a grace period for annual code sets. The new HIPAA Transaction and Code Set Rule requires providers to use national medical code sets that are valid at the time that a service is provided. ICD-9-CM code revisions become effective October 1st each year while CPT and HCPCS code revisions become effective January 1st. In order for you to meet this requirement, you must have the revised CPT, HCPCS, and ICD-9-CM codes in your possession before the implementation dates. The best way to do this is to order your code books early.

Review current coding resources.

You may also be interested in combining this important book with the complete CodeManager software and coding data files.

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