Conduct self-audits of OIG Work Plan targets

Why This Topic Matters

Urology practices can use the OIG Work Plan as a roadmap for internal compliance review and risk assessment. Understanding the general areas under investigation can help practices identify billing processes that may warrant closer audit attention.

Article Sections

1. Background

   Introduces the OIG Work Plan and explains its role in identifying areas of Medicare and Medicaid oversight focus. It also frames the article as a guide for practice-level audit preparation.

2. New investigations now being launched

   Summarizes the newer Work Plan topics singled out as current areas of review. The section focuses on broad compliance concerns in physician practice and hospital-related billing environments.

3. Modifier GY

   Discusses OIG attention to claims associated with this modifier and the broader compliance concerns linked to noncovered services under Medicare.

4. Hospital ownership of physician practices

   Reviews OIG scrutiny of reimbursement issues involving hospital-owned physician practices with provider-based designation. It places the topic in the context of Medicare payment settings.

5. Continuing investigations from last year

   Outlines several Work Plan areas that remain under review from prior years. These topics include claim coding and billing practices across office, facility, and post-operative care settings.

6. Place of service (POS) errors

   Covers review of place-of-service reporting on claims submitted from different outpatient settings. The discussion is centered on how setting differences can affect reimbursement and audit risk.

7. Incident-to billing

   Addresses OIG interest in services performed by nonphysician staff in physician offices. The section describes the oversight concern as relating to staffing qualifications and service vulnerability.

8. E/M billed during global surgery period

   Discusses review of evaluation and management services reported in relation to the global surgery period. It also notes attention to post-operative follow-up scenarios and related transfer-of-care considerations.

9. Long-distance claims requiring face-to-face visit

   Summarizes OIG review of claims associated with patients living at a distance from the physician. The section focuses on the broader circumstances that may contribute to such claims.

10. Official resources

    Lists external government references for the Work Plan and Medicare manual chapters cited in the article. These resources are provided for readers seeking the underlying policy documents.