decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 11 (November)
Conduct self-audits of OIG Work Plan targets
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Article Overview
This article reviews selected items from the Office of Inspector General’s annual Work Plan that are especially relevant to ophthalmology practices. It focuses on broad areas of Medicare compliance scrutiny, including billing practices, place-of-service reporting, global surgery-related issues, and hospital-owned practice arrangements, with references to CMS guidance sources that support further review.
Why This Topic Matters
It helps ophthalmology practices identify where federal auditors are concentrating attention so they can evaluate internal billing and documentation processes for Medicare compliance.
Article Sections
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Background on the OIG Work Plan
Introduces the OIG Work Plan as a source of national audit priorities and explains why it is useful for practice self-review. The section also places the discussion in the context of HHS oversight activity.
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New investigations affecting ophthalmology practices
Summarizes several newly highlighted review areas that may be relevant to ophthalmology practices. It frames the compliance topics at a high level without delving into coding conclusions.
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Continuing areas of review from prior years
Outlines additional compliance topics that remain under scrutiny from prior Work Plan cycles. The section groups together recurring audit themes involving claims processing, service settings, and related Medicare payment issues.
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Official resources
Lists source documents and public reference materials cited by the article. These resources are provided for readers who want to consult the underlying Medicare and OIG guidance.
What You Will Learn
- Which broad OIG audit priorities are most relevant to ophthalmology practices
- How the article frames Medicare compliance review areas of interest
- What types of CMS and OIG reference materials are cited for further reading
- Which recurring billing and reimbursement topics continue to attract audit attention
Who Should Read This
- Ophthalmology practices
- Medical coders
- Coding auditors
- Compliance staff
- Practice managers
- Physician billing teams
Codes Discussed
Modifiers Discussed
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