Is your organization aligned with upcoming state Medicaid program compliance initiatives?

(PYA Alert dated July 20, 2006)


Doug Colburn, Inspector General for the Georgia Department of Community Health, spoke before a June 9, 2006 Compliance Officer Roundtable meeting at the Georgia Hospital Association to lend insights. Of topics discussed, chargemaster review was indicated as an upcoming “major area of focus” where both generalized pricing and DRG outlier payments are concerned. Pharmacy charges will receive heavy scrutiny, considered the “number one impact”, closely followed by Laboratory and Radiology services. These will be of particular significance where increases are demonstrated or appear otherwise disproportionate to an item (example - $125 tube of petroleum jelly, $50 for two Tylenol, etc.), or, where they otherwise bear impact on DRG outliers. Billing for anesthesia services will soon receive attention as well, such as where CRNA’s are appropriately monitored and/or a physician is present as required.

Mr. Colburn suggested that hospital Compliance Officers will play a critical role in coordinating internal mechanisms as it relates to above and helping advise their organizations to areas of concern.

Our Clinical Compliance and Reimbursement team is available to assist you in performing charge master review, identifying areas of potential risk, evaluating financial impact to your organization, and analyzing areas where process enhancements should be considered. Please contact Denise Hall or Carol Eyer at (800) 270-9629.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

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