after the compliance officer for xyz internal medial group identifies a provider as an outlier or different vulnerabilities are identified with risk ratings, what is an important next step? a. perform an audit and a peer review. b. provide training and develop a corrective action plan. c. perform an audit and implement disciplinary actions. d. perform an audit and develop a corrective action plan.

The development of an audit and corrective action plan is a crucial next step once Carol, the compliance officer at XYZ Internal Medical Group, recognizes a provider as an outlier or after various vulnerabilities are found with risk ratings.

Are third party healthcare organizations, such billing offices, have to follow the OIG criteria for a compliance program?

Every provider who works with Medicare, Medicaid, or both is subject to mandatory compliance obligations from the OIG and other organizations, in addition to an ACA requirement for a comprehensive compliance plan. The AdvantEdge compliance plan is based on the OIG Compliance Program Guidance for Third-Party Medical Billing Companies.

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