decisionhealth Newsletters, Coder Pink Sheets - 2007 Issue 11 (November)
OIG picks its targets for 2008 Work Plan
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Article Overview
This article summarizes the Office of Inspector General’s 2008 Work Plan and highlights the broad compliance and audit areas likely to affect physician practices, especially anesthesia and pain management. It is relevant for coders, billers, compliance staff, and practice managers who need a general view of the oversight topics CMS and OIG planned to review, including billing location, global surgical periods, medical necessity, documentation, and technology initiatives.
Why This Topic Matters
It helps practices identify the kinds of billing and compliance areas that were under federal review so they can assess internal risk and documentation readiness.
Article Sections
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Incident-to
Discusses federal and program-related billing compliance considerations for services furnished incident to physician services, including the general compliance focus for Medicare and Medicaid.
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Place of Service errors
Covers review of billing location accuracy and how service setting can affect claim payment patterns under Medicare.
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E/M services during global surgery periods
Summarizes oversight attention on evaluation and management services furnished around surgical procedures during the global period.
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Assignment rules
Addresses Medicare assignment-related billing compliance and concerns about beneficiary billing practices.
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Interventional pain management procedures
Reviews the Work Plan’s focus on a growing pain management specialty and the general issue of medical necessity for certain procedures.
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Geographic areas with high utilization of ultrasound
Describes scrutiny of regional ultrasound billing patterns, utilization levels, and related documentation concerns.
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Geographic areas with a high density of independent diagnostic testing facilities
Covers review of billing and service patterns in areas with many independent diagnostic testing facilities.
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High-frequency chiropractic treatments
Summarizes oversight of chiropractic billing patterns, coverage compliance, and documentation expectations.
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Physician reassignment of benefits
Discusses review of physician benefit reassignment activity and the potential for abusive or fraudulent schemes.
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Serious medical errors
Covers studies related to serious medical errors, facility response, and reporting of adverse events.
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Doctors’ Office Quality Technology Initiatives
Addresses CMS efforts to promote health information technology adoption in physician offices, including electronic health records.
What You Will Learn
- The main oversight topics included in the OIG’s 2008 Work Plan
- Which broad billing and documentation areas were of concern to federal reviewers
- How the article frames compliance issues for anesthesia and pain practices
- What kinds of practice operations and service patterns were under review
- Which technology and quality initiatives were being evaluated at the time
Who Should Read This
- Anesthesiologists
- Pain management physicians
- Medical coders
- Medical billers
- Compliance officers
- Practice managers
Codes Discussed
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