Healthcare DIVE November 7, 2022
Staying compliant with federal and state requirements for monitoring your referring and ordering physicians, a historically tricky population to monitor, can be challenging – especially in a constantly changing healthcare environment. When receiving an order or referral, data can be limited and disparate across systems making compliance verifications difficult. The nuances in workflows between ordering and referring populations may also complicate your processes for ensuring compliance. Continuous compliance begins with automated monitoring, cross-departmental communication and population-specific workflow.
Using the OIG’s Special Advisory Bulletin as a guideline, we can first identify a few key elements in monitoring exclusions and OIG expectations. The Special Advisory Bulletin states that “no Federal healthcare program payment may be made for any items or services furnished...
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