OIG Work Plan / 2011 Work Plan

Why This Topic Matters

The OIG Work Plan signals where Medicare oversight and audit activity may intensify, making it useful for compliance planning and internal review. Understanding the broad categories of review helps organizations monitor documentation, billing, and appeals processes at a strategic level.

Article Sections

1. Payments for E/M services

   Discusses a Medicare oversight target related to evaluation and management payment review and documentation consistency.

2. Coding E/M services

   Describes planned review of E/M claim coding patterns and provider-related variation.

3. E/M services during the global period

   Covers a recurring oversight topic involving E/M services furnished during global surgical periods.

4. Modifiers GA & GZ

   Summarizes planned review of claims associated with these Medicare billing modifiers and the providers and services involved.

5. Medicare billing with Modifier GY

   Notes planned scrutiny of claims submitted with this modifier and the compliance concerns associated with its use.

6. Place of Service errors

   Addresses review of place of service coding in outpatient and ambulatory surgery center settings.

7. Error-prone providers

   Describes use of CERT data to identify providers with repeated claim error patterns over multiple years.

8. Payments for drugs

   Summarizes planned review of Medicare Part B drug payment rules and related billing oversight.

9. Local Coverage Determinations

   Covers study of LCD impact on Medicare spending, coverage, and contractor oversight.

10. Level 1 appeals

    Describes review of Medicare contractor processes for first-level appeals and redetermination timing.

11. ALJ appeals

    Summarizes planned review of Administrative Law Judge appeal characteristics and hearing processes.