BC Advantage - 2016 Issue 3
WHAT'S ON THE OIG RADAR FOR 2016?
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Article Overview
This article summarizes a portion of the 2016 HHS Office of Inspector General Work Plan and explains why providers, billing staff, and compliance teams should pay attention. It covers selected oversight topics involving Medicare payment, documentation, and monitoring activities across multiple provider types, along with the general compliance environment surrounding audits and recoupment efforts. The piece is aimed at readers who need a broad understanding of the Work Plan’s scope and the kinds of provider issues OIG was reviewing that year.
Why This Topic Matters
The article helps healthcare organizations understand the categories of Medicare oversight that were drawing OIG attention in 2016 so they can assess whether their own billing, documentation, and compliance processes may be affected.
Article Sections
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OIG Work Plan overview
Introduces the annual HHS OIG Work Plan and describes its broad oversight role across federal healthcare programs and operations.
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Other Providers – Policies and Practice Issues
Summarizes selected provider-focused topics included in the 2016 plan and frames them as areas of policy, payment, quality, and oversight interest.
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Ambulatory surgical centers
Covers selected oversight themes involving ambulatory surgical center quality and payment monitoring.
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End-stage renal disease facilities
Discusses Medicare payment system review activities related to dialysis services and related drugs.
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Ambulance services
Addresses ongoing review of billing and transport-related oversight for ambulance claims.
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Anesthesia services
Reviews Medicare Part B claims oversight related to anesthesia reporting and claim form compliance.
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Independent Clinical Laboratory billing requirements
Covers compliance and payment analysis topics involving independent clinical laboratories and Medicare billing requirements.
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Physical therapists
Summarizes review activity focused on outpatient physical therapy utilization and supporting documentation.
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Sleep disorder clinics
Discusses scrutiny of higher-volume sleep-testing services and related Medicare payment oversight.
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Physicians-referring/ordering Medicare services and supplies
Addresses review of ordering and referral-related requirements for selected Medicare services, supplies, and equipment.
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Compliance and audit readiness
Provides general discussion of compliance programs, documentation, audit preparedness, and the broader enforcement environment.
What You Will Learn
- What the 2016 OIG Work Plan emphasized for selected provider types
- Which broad Medicare oversight areas were highlighted in the article
- Why compliance, documentation, and billing review are important for audit preparedness
- How the article frames provider vulnerability to audits and recoupment efforts
Who Should Read This
- Healthcare providers
- Medical practice administrators
- Billing and coding staff
- Compliance officers
- Revenue cycle professionals
- Healthcare consultants
Codes Discussed
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