decisionhealth Newsletters, Coder Pink Sheets - 2011 Issue 10 (October)
OIG 2012 Work Plan: Expect more E/M, incident-to investigations
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Article Overview
This article reviews selected items from the HHS Office of Inspector General’s 2012 Work Plan that are relevant to physician practices and compliance staff. It focuses on the government’s planned reviews of Medicare billing patterns, documentation and payment oversight, and other recurring audit priorities. The piece is useful for coders, auditors, compliance officers, and practice administrators who want a high-level view of emerging oversight themes.
Why This Topic Matters
The article highlights areas the OIG intended to scrutinize more closely, helping healthcare organizations identify where internal compliance reviews may be most useful. It is especially relevant for practices that bill Medicare and want to understand the general types of audits and investigations emphasized in the work plan.
Article Sections
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E/M and global period oversight
Discusses planned government review areas related to evaluation and management billing during the surgical global period and broader coding trend monitoring.
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Incident-to billing
Summarizes the planned examination of incident-to services and related oversight of payment accuracy and monitoring practices.
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High cumulative Part B payments
Covers the planned review of unusually high cumulative physician or supplier payments over a defined period.
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Drug wastage and Herceptin payments
Addresses planned review of payments tied to drug wastage claims and related oversight of selected Part B drug billing issues.
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Repeat areas of interest
Lists other continuing Work Plan focus areas involving coding, place of service, imaging, sleep testing, and electronic health record incentive payments.
What You Will Learn
- Which compliance and billing areas were highlighted in the OIG’s 2012 Work Plan.
- How the article frames Medicare oversight priorities for physician practices.
- What broad categories of billing and coding issues were under review or continued as repeat audit topics.
- Which specialties and practice functions are most likely to care about these oversight themes.
Who Should Read This
- Physician practices
- Medical coders
- Compliance officers
- Practice administrators
- Healthcare auditors
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