The Office of the Inspector General (OIG) issues its Workplan annually. Inpatient Psychiatric Facility Outlier Payments have been added as a newly identified issue under scrutiny on the workplan. Many organizations are conducting self-criticality audits of their medical records to validate compliance with the rule including certification and re-certification. It is important to note that the use of a certification form itself is not required in order to show compliance. Use of a form is a helpful tool in prompting clinicians for the certification and for tracking purposes however. When conducting an audit, the key is to ensure that documentation exists in the medical record certifying the patient’s continued need for the level of care and expected length of stay, and these notes are authenticated by the treating psychiatrist within the timeframe required under the rules.

If you need help with audits or certification related to these payments, please contact Linda Mancini.