12/17/2010 1 20 11 OI G WO RKP LAN INCREASING REVENUES IN THE BUSINESS OFFICE Richard S. Blauvelt, BA, MHSM President/CEO PRO-DOC SOLUTIONS 2011 OIG Work Plan for Physicians Presented by Jennifer Hume, CPC, CPMA, CEMC 2011 OIG WORKPLAN FOR PHYSICIANS OIG WORKPLAN 2 • Released on October 1 of each year • Coincides with the start of the new fiscal year for the government • Lists key investigative priorities. • Multiple “parts” -Part 1 addresses Medicare Part A and Part B services.
Transcript
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LANINCREASING REVENUES IN THE BUSINESS OFFICE
Richard S. Blauvelt, BA, MHSM
President/CEO
PRO-DOC SOLUTIONS
2011 OIG Work Plan for Physicians
Presented by Jennifer Hume, CPC, CPMA, CEMC
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OIG WORKPLAN
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• Released on October 1 of each year
• Coincides with the start of the new fiscal year for the government
• Lists key investigative priorities.
• Multiple “parts”-Part 1 addresses Medicare Part A and Part B services.
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SOIG WORKPLAN—PART 1
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Provider Types
HospitalsHome Health Agencies
Nursing Facilities
Other Providers & Suppliers
Medical Equipment & Supplies
Part B Payments for Prescription Drugs
Medicare Part A and Part B Contractor Operations
Addresses many different provider types
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OIG WORKPLAN—PART 1
• Evaluation and Management Services
• Diagnostic Testing
• Medicare Program – General
• Medical Necessity
• Comprehensive Error Rate Testing
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SOTHER PROVIDERS AND SUPPLIES
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Evaluation and Management Services
• Coding of E/M services
• Payments for E/M services
• E/M services during global surgery periods
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OTHER PROVIDERS AND SUPPLIES
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Diagnostic Testing
• Appropriatness of Medicare payments for polysomnography
• Medicare payments for sleep testing
• Excessive payments for diagnostic tests
• Medicare payments for Part B imaging services
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SOTHER PROVIDERS AND SUPPLIERS
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Medicare Program – General
• Medicare providers’ compliance with assignment rules
• Payments for services ordered or referred by excluded providers
• Medicare services billed with dates of service after beneficiary’s date of death
• Place of service errors
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OTHER PROVIDERS AND SUPPLIERS
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Medical Necessity
• Medicare payments for claims deemed not reasonable and necessary
Ambulatory surgery centers Partial Hospitalization Services
Providers other than physicians
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SOTHER WORKPLAN PARTS
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Don’t limit workplan reviews to just the other providers and suppliers section
• Hospital: Medicare Secondary Payer/Other Insurance Coverage: We will
review Medicare payments for beneficiaries who have other insurance. Pursuant to the Social Security Act, § 1862(b), Medicare payments for such beneficiaries are required to be secondary to certain types of insurance coverage. We will assess the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with other insurance coverage. For example, we will evaluate procedures for identifying and resolving credit balance situations, which occur when payments from Medicare and other insurers exceed the providers’ charges or the allowed amounts. (OAS; W‐00‐11‐35317; various reviews; expected issue date: FY 2011; new start)
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HOW TO USE THE WORKPLAN
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• Review when issued
• Identify key investigative priorities that may affect your
practice
• Incorporate into your annual compliance audit plan
Example: General surgical practice and E/M services
