AMA Clinical Examples in Radiology - 2009 Bulletin 2
U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to Review Radiology Payments and Appropriateness
U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to Review Radiology Payments and Appropriateness According to the recently released OIG Fiscal Year 2010 Work Plan, the HHS OIG will open new studies regarding Medicare Part B imaging payments and the appropriateness of many emergency department scans. The OIG functions under Congress' mandate to review health care-related programs and operations. The Work Plan is the OIG's annual "playbook" of upcoming investigations, audits, and reports. Its work plan lists health care arrangements that it believes cost too much financially or could violate federal fraud-and-abuse laws...
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Article Overview
This article reviews an HHS Office of Inspector General work plan update relevant to radiology and related Medicare oversight. It is intended for radiologists, imaging practices, and coding/billing staff who need to understand the types of payment, documentation, and compliance areas under review. The discussion focuses on broad audit and review themes involving imaging payments, emergency department imaging, diagnostic facilities, and clinical trial oversight.
Why This Topic Matters
The article helps readers identify current government review priorities that may affect radiology operations, billing compliance, and documentation practices. It is useful for organizations trying to understand which imaging and payment areas may face increased scrutiny.
Article Sections
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Overview of the OIG Work Plan and Radiology Focus
Introduces the HHS OIG work plan and explains why certain health care services and arrangements are selected for review. Summarizes the article’s focus on radiology-related payment oversight and compliance concerns.
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Medicare Part B Imaging Payment Review
Describes planned examination of imaging payment components and related practice-expense issues. References broader questions about utilization assumptions and payment methodology.
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Emergency Department Imaging and Diagnostic Facility Reviews
Covers anticipated review topics involving emergency department imaging and services in areas with a high concentration of diagnostic testing facilities. Highlights the compliance and billing areas being monitored.
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Clinical Trial Safety Monitoring Review
Summarizes the planned inspection of safety monitoring practices in clinical trials. Notes the relevance for physician practices participating in research settings.
What You Will Learn
- Which radiology-related oversight topics are included in the OIG work plan
- How Medicare imaging payment reviews are framed at a high level
- What types of emergency department imaging and facility issues are under review
- Why clinical trial safety monitoring appears in the work plan
- Which stakeholders may want to monitor these oversight developments
Who Should Read This
- Radiologists
- Radiology billing staff
- Imaging practice managers
- Compliance professionals
- Physician practices involved in clinical trials
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