RESOURCES AND CITATIONS OIG Compliance Guidance Http//oighhsgov/fraud/complianceguidancehtml Http//oighhsgov/fraud/complianceguidancehtml2 OIG

resources and citations oig compliance guidance: http://oig.hhs.gov/fraud/complianceguidance.html http://oig.hhs.gov/fraud/compliancegu

RESOURCES AND CITATIONS
OIG Compliance Guidance:
http://oig.hhs.gov/fraud/complianceguidance.html
http://oig.hhs.gov/fraud/complianceguidance.html#2
OIG Exclusions: http://oig.hhs.gov/fraud/exclusions.html
Federal Register:
http://www.gpoaccess.gov/fr/index.html
Code of Federal Regulations:
http://www.gpoaccess.gov/cfr/index.html
Federal Sentencing Guidelines:
http://www.ussc.gov/guidelin.htm
OIG Fraud Alerts: http://oig.hhs.gov/fraud/fraudalerts.html
OIG Workplan(s): http://oig.hhs.gov/publications/workplan.html
OIG Safe Harbors: http://oig.hhs.gov/fraud/safeharborregulations.html
OIG Advisory Opinions: http://oig.hhs.gov/fraud/advisoryopinions.html
CMS E&M Documentation Guidelines:
http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp
Comprehensive Error Rate Testing (CERT):
http:www.cms.hhs.gov/CERT
http:www.cms.hhs.gov/CERT/CR/list.asp
http:www.cms.hhs.gov/MLNProducts/downloads/certfactssheetv1-3.pdf
HIPAA:
http://www.cms.hhs.gov/HIPAAGenInfo/
CMS INTERNET ONLY MANUALS (IOM)
http://www.cms.hhs.gov/Manuals/IOM/list.asp
CMS Reciprocal Billing & Locum Tenen Rules: Internet Only Manuals
(IOM), CMS Pub 100-04, Chapter 12, §30.2.10-30.2.11. Paper Manual:
Claims Processing Manual §30.60
Shared Visits:
Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §30.6.1.
Paper Manual: Pub 14, MCM Part 3, §15501, Transmittal 1832.
IDTF Regulations:
42CFR 410.33
Teaching Physicians:
Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §100.1.8
Consultations:
Internet Only Manuals (IOM), CMS Pub 100-04, Chapter 12, §30.6.1
“Incident to”:
Internet Only Manuals (IOM), CMS Pub 100-02, Chapter 15, §60.1-60.3
CLIA:
http://www.cms.hhs.gov/CLIA/
Medicaid state fraud statutes:
http://www.cms.hhs.gov/FraudStateStatutes
Medicare national physician fee schedule look-up:
http://www.PFTlookup/
**Includes payment policy indicators
RVU
Modifiers
GPCI
NCCI:
http://www.cms.hhs.gov/NationalCorrectCodiNitEd/01­_overview.asp
**Includes Manual
Code pairs, including effective dates
Modifier 59 instructions
Medicaid Fraud:
http://www.cms.hhs.gov/DeficitReductionAct/02_ CMIP.asp_ TopOfPage
National and Local Coverage determinations database (NDC and LCD)
http://www.cms.hhs.gov/CoverageGenInfo/01_ overview.asp
http://www.cms.hhs.gov/MCD/search.asp
Educational Publications and web based training:
http://www.cms.hhs.gov/MLNEdWebGuide
http://www.cms.hhs.gov/MLNMattersArticles/
Health provider and specialty shortage bonus (HPSA and PSA):
http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/Downloads/instructions.pdf
CMS Forms:
http://www.cms.hhs.gov/CMSForms/list.asp#TopOfPage
Quarterly Provider Updates:
http://www.cms.hhs.gov/QuarterlyProviderUpdates/
Physician Quality Reporting Initiative (PQRI):
http://www.cms.hhs.gov/pqri/
Healthcare provider and specialty shortage areas:
http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/Downloads/instructions.pdf
http://www.cms.hhs.gov/HPSAPSAPhysicianBonuses/Downloads/Carrier_Web_Sites.pdf
Medicare CPT statistics, including E&M by specialty:
http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/04_MedicareUtilizationforPartB.asp#TopOfPage
CMS transmittals database:
http://www.cms.hhs.gov/transmittals
Enrollment:
http//www.cms.hhs.gov/MedicareProviderSupEnroll/
NPI:
http:www.cms.hhs.gov/NationalProvIdentStand/
RESOURCES TO HELP EVALUATE COMPLIANCE OFFICER KNOWLEDGE AND EXPERTISE
HCCA sample test:
http://www.hcca-info.org/AM/Template.cfm?Section=Home
From the home page, choose HCCB Certification and then select practice
exam
CMS webbased training modules (multiple tested topics):
http://www.cms.hhs.gov/MLNEdWebGuide/
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