OIG Work Plan 2012

April 2nd, 2012 - Codapedia Editor
Categories:   Compliance   Medicare  
0 Votes - Sign in to vote or comment.

The Office of Inspector General released its Work Plan for 2012. As in past years, the Work Plan describes the areas of interest that the OIG will investigate in the coming year. There are sections for hospitals, nursing homes, and of course, physicians.  

There is a pdf file attached to this article with the Part A and Part B sections of the Work Plan.  The relevant section for physicians is listed as “Other Providers and Suppliers.”

 

For each area, CMS lists the topic and gives brief description of what they are investigating, and why.  The descriptions are succinct and the reader is often left to interpret the why.  Some of the topics are new starts (issues that the OIG is beginning to work on in the coming year) and some are works in progress (projects started the previous year, not yet complete.)

 

It is critical for physician practices to review the topics on the OIG Work Plan each October.  Compare the OIG list to services performed in the practice.  Review the coding rules for each topic on the list that is done in the practice, and decide if the practice needs an internal audit.  If so, add it to the practice's own Compliance Plan for the year.

 

Evaluation and Management services remain on the Work Plan, as both continued items and new starts.  The OIG is going to analyze E/M services provided during the global period (look at your use of modifiers 24, 25 and 57), at trends in the coding of claims and at identical or cloned notes.  The OIG is also reviewing—again—services provided incident to a physician service and physicians with high, cumulative payments.  What should you do?  Be sure that all providers are enrolled in Medicare, and bill services under the correct provider number.  Review the use of modifiers 24, 25, and 57 in your practice, and compare your profile to the norms for your specialty in terms of E/M levels of service.

 

There are indications that the OIG is going to review the quality of care received by Medicare patients.  One of the topics on he work plan about Ambulatory Surgical Centers, looking at safety and the quality of procedures.

 

The OIG is also looking at the “appropriateness of payments” in various areas, including physical therapy, sleep clinics and partial hospitalization programs.    Lab payments and payments for End Stage Renal Disease are on the plan this year. 

 

Do you submit claims with modifiers GA or GZ?  Those claims will be reviewed this year. 

 

Take the time to download the pdf attached to this article and review it.  If your practice provides services that are on the Work Plan, do your own internal review as part of your 2012 compliance activities.

 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

CMS and HHS Tighten Enrollment Rules and Increase Penalties
October 1st, 2019 - Wyn Staheli, Director of Research
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019. There have been known problems ...
Federal Workers Compensation Information
October 1st, 2019 - Wyn Staheli, Director of Research
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program. Division of Federal Employees' Compensation (DFEC) website Division of Federal Employees' Compensation (DFEC) provider ...
E-Health is a Big Deal in 2020
September 16th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
The new 2020 CPT codes are on the way! We are going to see 248 new codes, 71 deletions, and 75 revisions. Health monitoring and e-visits are getting attention; 6 new codes play a vital part in patients taking a part in their care from their own home. New patient-initiated ...
Chiropractic 2020 Codes Changes Are Here
September 9th, 2019 - Wyn Staheli, Director of Research
There are some interesting coding changes which chiropractic offices will want to know about. Are codes that you are billing changing?
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
September 9th, 2019 - Wyn Staheli, Director of Research
Question Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI? Answer You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
List of Cranial Nerves
September 3rd, 2019 - Find-A-Code
Cranial nerves are involved with some of our senses such as vision, hearing and taste, others control certain muscles in the head and neck. There are twelve pairs of cranial nerves that lead from the brain to the head, neck and trunk. Below is a list of Cranial Nerves and ...
So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?
August 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...



About Codapedia by InnoviHealth Systems Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™ by InnoviHealth Systems™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association