Pre-pay vs post-pay audits

maine4me

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I am currently developing the internal auditing program for our group of practices (multispecialty). I started with our family practices and have completed the baseline audits. I did these as post pay audits because I felt it would be more difficult to get a fair sampling for the baseline audits if conducted as prepay. Now, I am wondering if I should change my process and pull all audited charts prepay, rather than postpay.

Now, someone recently reminded me of the OIG requirement that if a problem is discovered during a prepay audit and it likely existed on prior visits, you are
obligated to go back and review services already billed to determine the extent of
the problem and pay the money back.

So, I looked for this information on the OIG sight, and came up empty. I am sure it is there but I am just not looking in the correct place.

Two questions:

1. Can anyone advise me of whether they do post pay or pre pay audits, or a combination of both and why?
2. Does anyone know where I can find the OIG information indicated above?
 

mtimson

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Step 5

Hello,

From what i have understood the OIG recommends doing both pre and post payment audits.

Regarding if a problem is identified i would look at step 5 of the OIG Individual and Small Group Physician Practice.

http://oig.hhs.gov/authorities/docs/physician.pdf

The page number located top right corner 59443

Hope this helps!
 
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