OIG-Aligned Audit Readiness Checklist

Turn OIG Priorities Into an Audit-Ready Plan

eClinicalWorks gives you detailed claims and clinical documentation. What it can't tell you is whether those records would hold up against this year's OIG risk areas. That takes a structured review layered on top.

This checklist breaks the relevant OIG Work Plan priorities into 30 audit items across six risk areas. Assign an owner, set a target date, log the supporting evidence, and the same process runs again next quarter instead of starting from scratch.

What's Inside This Checklist?

Six risk areas, thirty checkpoints, built to point outpatient compliance reviews at what OIG is actually looking at right now.

1. Chronic Care Management & Modifier 25 Risk Review

• CCM eligibility, time logs, care plans, and consent all get checked in one pass, along with any overlapping services
• E/M claims billed with modifier 25 next to a minor procedure get pulled for review
• Does the documentation actually support a separate, identifiable E/M service? That's the question this section answers
• Provider-level utilization patterns get flagged when they warrant a closer chart pull

2. Telehealth & Behavioral Health Compliance

• Modality, place of service, modifiers, licensure, and consent—the full telehealth claim gets checked end to end
• Flags potential overlap between a telehealth visit and an in-person claim for the same encounter
• Behavioral health credentialing and psychotherapy add-on documentation get reviewed together
• Opioid treatment and tele-behavioral health billing requirements are covered where they apply

3. Medicare Advantage Risk Adjustment & HCC Coding

• Every HCC diagnosis needs current-year encounter documentation behind it. This confirms it's actually there
• Diagnoses added through retrospective chart review get a second look
• Provider sign-off on EHR-prompted diagnosis suggestions gets validated, not assumed
• Annual recapture practices for chronic conditions get checked year over year

4. Documentation, Coding & Audit Program Foundations

• Coder and CDI credentials, training records, and query processes all get reviewed
• An internal audit calendar gets built across every risk area identified above
• Corrective actions get tracked back to a named owner and a real target date
• EHR templates, late entries, addenda, and amendment policies close out the review

Built for Healthcare Leaders Responsible for Audit & Compliance Readiness

Designed for teams responsible for translating regulatory priorities into structured reviews, documented actions, and stronger billing and coding oversight.

Compliance Officers

Turn this year's OIG risk areas into assigned, tracked audit items, so remediation doesn't fall through the cracks between compliance cycles.

Billing Directors & Managers

Spot the billing patterns and workflows that need a harder look before a payer or OIG finds them first.

Coding Managers & Auditors

Decide which charts to pull first, modifier 25, CCM, telehealth, HCC coding, using risk areas that are already prioritized for you.

Practice Administrators

Get one view of where audit readiness actually stands, who owns each gap, and when it's supposed to close, across every team involved.