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The Power of A Quality Review: Your Best Defense Against OIG Audits

Successful Review
Rebecca Darnall
Director of Product
February 16, 2023

This article was originally published in Healthcare IT Today on February 2, 2023 here.

You don’t have to be a fortune teller to see the future of auditing at the Office of Inspector General (or OIG). It has given every indication that it intends to investigate fraud, waste, and abuse more robustly in the foreseeable future. To that end, the agency doubled its budget for audits in 2022. The clear message is to expect — and prepare for — more audits.

The best way to prevent a potentially damaging OIG audit is to audit yourself proactively. Realize that, in this era of increased scrutiny, the industry gold standard of 95% coding accuracy might not be good enough anymore.

For many reasons, a quality assurance program might be a payer organization’s best friend. These programs stress the importance of arriving at supportable diagnoses and charting the diagnoses effectively, which leads to more accurate submissions to the Centers for Medicare & Medicaid Services (or CMS). In turn, this should also build more meaningful connections between providers and members as they work together to document and promote patient health.

To read more, visit our article in Healthcare IT Today here.