2013 OIG Work Plan: Expect scrutiny of electrodiagnostic claims, G modifiers

Why This Topic Matters

The Work Plan signals where federal scrutiny may increase, helping practices identify billing and documentation areas that may warrant internal review. It is especially relevant for organizations that perform electrodiagnostic testing, submit claims involving ABN-related modifiers, or bill for drugs and physician services under Medicare.

Article Sections

1. Electrodiagnostic tests

   Discusses the Work Plan focus on electrodiagnostic services and related utilization review trends. The section also notes the associated physician billing context and specialty-level interest.

2. Proper billing of liability-related G modifiers

   Summarizes the Work Plan item involving liability-related G modifiers on Part B claims. The section addresses audit attention to claims signaling denial-related circumstances.

3. Payments for immunosuppressive drug claims with modifier KX appended

   Covers the Work Plan’s interest in immunosuppressive drug claims and documentation review. It also places the topic in the context of transplant-related services.

4. New OIG drug shortages investigation

   Describes the OIG’s planned review of drug shortages and how providers respond to them. The section focuses on operational and market-impact concerns associated with shortages.

5. Perennial problem areas

   Notes several recurring billing and coding risk areas that OIG continues to monitor. These topics are presented as ongoing compliance concerns for physician practices.