OIG focuses on error-prone providers, E/Ms and EHR bonuses in 2011

Why This Topic Matters

The article helps readers understand which billing and compliance areas were being emphasized by federal oversight in 2011, especially for practices that bill Medicare or participate in EHR incentive programs. Knowing these review priorities can help organizations assess risk areas and prepare for external audits or documentation review.

Article Sections

1. OIG 2011 work plan overview

   Introduces the main oversight themes in the 2011 work plan and the broad categories of Medicare claims and incentive payments under review.

2. Error-prone providers

   Discusses the plan to identify providers with patterns of claim errors using CMS data sources and related review activity.

3. EHR bonuses and attestation

   Covers review of incentive payments and whether practices met the general requirements associated with EHR adoption and reporting.

4. Coding of E/M services

   Summarizes planned analysis of evaluation and management coding trends and provider billing patterns.

5. Similar documentation

   Describes planned review of claims with comparable documentation and the use of EHR-generated records in claims review.

6. Appeals

   Notes review of the first level of the Medicare appeals process and contractor timeliness in redeterminations.

7. Medicare Secondary Payer

   Addresses evaluation of Medicare Secondary Payer overpayment recovery operations and their administrative impact.

8. RACs and CMS oversight

   Summarizes OIG review of the Recovery Audit Contractor program and CMS oversight responsibilities.

9. Uncollectable claims

   Covers review of overpayments classified as currently not collectible and related program vulnerability concerns.

10. Local coverage determinations (LCDs)

    Discusses review of CMS monitoring of local coverage policies and their overall impact.

11. Impact of CMS education and outreach

    Describes assessment of whether education and outreach efforts reduced billing and payment error rates.

12. Place-of-service errors

    Covers review of place-of-service coding on Part B claims in ambulatory surgical center and hospital outpatient settings.

13. E/M services billed during global periods

    Addresses continued monitoring of evaluation and management services reported during global surgery periods.

14. Payments for Part B imaging services

    Summarizes planned review of payment components and utilization assumptions for Part B imaging services.

15. Necessity of diagnostic tests

    Covers review of duplicated diagnostic testing and payment patterns across physicians.

16. IDTF overutilization

    Discusses analysis of billing patterns for independent diagnostic testing facilities in selected geographic areas.

17. IDTF compliance with Medicare

    Addresses continued review of compliance with Medicare enrollment, licensing, and regulatory requirements for diagnostic facilities.