decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 10 (October)
OIG plans to look at pay rates of hospital-owned physician practices
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Article Overview
This article reviews several HHS Office of Inspector General agenda items from the 2009 Work Plan that are relevant to physician practices, hospital-based billing, outpatient payment arrangements, and Medicare claim oversight. It is useful for coders, compliance staff, practice administrators, and billing professionals who want a broad view of the agency’s audit and review priorities for the coming year. The discussion covers hospital-owned physician practices, unlisted procedures, Medicare claims with a specific modifier, diagnostic imaging in emergency departments, place-of-service reporting, global surgical period billing, physical therapy, incident-to services, and ultrasound utilization.
Why This Topic Matters
The article highlights areas the OIG planned to scrutinize for compliance and payment accuracy, helping practices understand where Medicare oversight may be focused and where internal review may be warranted.
Article Sections
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Hospital-owned physician practices and provider-based designation
Explains the OIG’s planned review of hospital-owned physician practices and broader payment issues tied to provider-based designation under Medicare outpatient payment systems.
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Unlisted code procedures
Summarizes the planned review of unlisted procedure usage and related carrier payment patterns.
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Medicare claims with the GY modifier
Covers the OIG’s planned examination of claims reporting patterns associated with a Medicare modifier used for certain non-covered services.
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Diagnostic X-rays in the emergency department
Describes the planned study of Medicare payment for emergency department diagnostic X-ray services and related claim trends.
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Where the X-ray re-read problem tends to crop up
Discusses the recurring concern involving multiple interpretations of the same emergency department imaging service.
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Other familiar Work Plan entries making a comeback next year
Lists additional OIG review topics involving physician billing, outpatient settings, surgical global periods, therapy services, incident-to services, and ultrasound utilization.
What You Will Learn
- Which Medicare payment and compliance areas the OIG planned to review
- How the article frames oversight of hospital-owned physician practices
- What categories of claims, services, and utilization patterns are included in the Work Plan discussion
- Which practice types and billing scenarios are highlighted for review
Who Should Read This
- Physician practice administrators
- Medical coders
- Billing staff
- Compliance professionals
- Orthopedic practices
- Hospital-owned physician practices
Modifiers Discussed
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