E/M, incident-to & POS remain in OIG crosshairs

Why This Topic Matters

The article helps practices recognize Medicare billing areas that may draw audit attention and prompts review of internal policies, documentation, and claim accuracy. It is especially useful for organizations that bill physician services across office, facility, and post-operative settings.

Article Sections

1. E/M billed during global period

   Discusses OIG attention to evaluation and management services reported during surgical global periods and the related compliance focus for physician practices.

2. POS errors

   Covers place of service reporting concerns for services rendered in facility settings, including outpatient and ambulatory surgery locations.

3. Incident-to billing

   Summarizes the OIG’s planned review of incident-to services and the associated focus areas for staff qualifications, documentation, and medical necessity.

4. Selected physician services

   Introduces the OIG’s broader review of physician services and possible concerns involving billing arrangements and service provision.

5. Polysomnography

   Notes OIG coverage of sleep study services and the need to consider Medicare coverage criteria and medical necessity.

6. MRI services

   Describes OIG review of relationships among physicians and billing entities involved in imaging services and their potential effect on utilization.

7. Ultrasound services

   Summarizes OIG interest in geographic areas with high ultrasound utilization.

8. Long-distance home health/nursing facility patients

   Covers payment review for physician services tied to home health and skilled nursing facility beneficiaries living far from the billing physician.

9. Medicare assignment rules

   Reviews OIG scrutiny of assignment rules and beneficiary billing practices under Medicare Part B.