OIG 2011 Work Plan focuses on E/M, outpatient therapy services

Why This Topic Matters

It helps practices identify the Medicare billing and documentation areas being emphasized in federal oversight so they can assess internal compliance and audit priorities.

Article Sections

1. E/M services in the 2011 Work Plan

   Introduces the OIG review focus on physician evaluation and management services and related billing and documentation themes. It also summarizes the broad scope of the planned studies.

2. Coding

   Describes a study of coding patterns for physician visits and the kinds of trends the agency plans to examine.

3. Documentation/payment

   Covers documentation and payment review concerns tied to electronic records and duplicated note patterns across services.

4. E/Ms during the global surgical period

   Addresses review of evaluation and management services reported around surgical episodes and related Medicare global surgery oversight.

5. Other OIG reports of interest to ortho

   Lists additional Work Plan topics of interest to orthopedic and other physician practices, including claim edits, payment issues, and billing review areas.

6. Modifiers GA & GZ

   Summarizes a planned review of claims associated with specific Medicare denial-related modifiers and the provider and service types involved.

7. Medicare billing with modifier GY

   Covers OIG attention to claims submitted with a modifier associated with statutorily excluded services.

8. Billing for Medicare Outpatient Therapy Services

   Describes a review of outpatient therapy claims data, utilization patterns, and compliance concerns for independent therapists.

9. Ambulatory Surgical Center payment system

   Addresses review of the ASC payment methodology and facility rate-setting approach.

10. Medicare Part B services during non-Part A nursing home stays

    Covers Medicare Part B services furnished during nursing home stays that are not covered under the Part A skilled nursing facility benefit.

11. Excessive payment for diagnostic tests

    Summarizes a planned review of high-cost diagnostic testing and related utilization patterns.

12. Place-of-service errors

    Discusses OIG review of place-of-service reporting for claims submitted in facility and nonfacility settings.