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March 27, 2018

Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More

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OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More

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Medical Coding News Archives

2008 OIG Workplan Released

October 16, 2007:
The Office of Inspector General (OIG) has released the 2008 workplan, giving providers a peek at what areas OIG and Medicare contractors will scrutinize in the upcoming year for possible errors, fraud and abuse, or potential Medicare savings.

Some of the areas that will be examined by the OIG for Part B claims include:

Place-of-service errors: Claims will be monitored for incorrect POS codes, particularly those claims for services performed in ambulatory surgery centers (ASCs) and hospital outpatient departments. OIG is interested in determining if physicians properly code the place of service on claims when services are provided in one of these locations.

Evaluation and management services during the global surgery period: The number of evaluation and management services provided by physicians during the global period will be reviewed to determine if the number of E/M services provided has changed since the inception of the global service period in 1992.

Incident-to services: Once again, services provided as “incident to” will be reviewed with a focus primarily on medical necessity, documentation, and quality of care—including appropriateness of staff. The report indicates that this will be performed on “selected physicians” but gives no indication of the criteria for selecting those providers.

Assignment rules: The OIG will also review Medicare claims to determine if the assignment rules are being appropriately adhered to. In particular, the focus will be on balance billing to determine if there is a pattern of providers’ billing Medicare patients more than Medicare allowed amounts. Medicare patient awareness of the balance billing guidelines will also be investigated.

High utilization: The OIG identifies a number of services it will review because of disproportionately high utilization in certain areas. These include ultrasound services and chiropractic treatments. Areas with a high density of independent diagnostic treatment facilities (IDTF) will also be reviewed with a focus on service, provider, and patient profiles and billing patterns. A 2006 report found numerous problems with IDTFs, including noncompliance with Medicare standards and potential improper payments of approximately $71.5 million. The specific areas are not identified.

Deborah C. Hall
Clinical/Technical Editor


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