BC Advantage - 2011 Issue 10

Validation of a Providers Right to Bill

How deep does your typical audit go?  If you are acting as a third party auditor/consultant and are performing a Compliance Audit for a client, is the coding and documentation all you are reviewing?  Often, an aspect of audits that we don't consider is the verification that the billing and performing provider are not excluded from participation in Federal health care programs.The OIG reports that to date, every month in 2011, there have been cases settled averaging $55,000 in settlements for this violation.  These settled cases are from various regions and do not appear...

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