Mastering Medical Necessity
And
OIG Compliance for Physician Practices
AGENDA
I.
OIG Compliance Plan
A.
B.
II.
1995 & 1997 Guidelines
A.
B.
III.
C.
D.
Diagnosis and management options
Data complexity
Risk
Signature Requirements
A.
VII.
General Exam
Specialty Specific Exam
The Medical Decision Making
A.
B.
C.
VI.
Chief Complaint
HPI
1.
Elements
PFSH
1.
Pertinent data
ROS
1.
Systems
The Exam
A.
B.
V.
Difference between 95 & 97
Difference between Initial visits and Follow ups
The History
A.
B.
IV.
Elements
1.
Auditing and monitoring
2.
Written Standards
3.
Compliance Officer
4.
Training and Education
5.
Response to Violations
6.
Communication
7.
Enforcement
HIPAA
1.
Awareness and Training
2.
Electronic Systems
3.
Gaps and Weakness
4.
Develop and Implement
Signature Guidelines
Auditing the Note
A.
Sample Notes
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