decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 11 (November)
OIG work plan: X-ray re-reads in ER get the once over in 2007
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Article Overview
This article summarizes several audit and compliance priorities in the HHS Office of Inspector General’s 2007 work plan. It is most relevant to coders, compliance staff, physicians, radiology and emergency department teams, and billing professionals who need to understand which areas of Medicare payment and documentation are under review. The discussion is broad and focuses on the types of services and claims areas being examined, along with the general compliance concerns tied to those reviews.
Why This Topic Matters
The article helps readers identify service lines and billing patterns that may receive heightened scrutiny, making it useful for compliance planning and internal review. It is especially relevant for organizations that bill Medicare for diagnostic imaging, therapy, DME, and related physician services.
Article Sections
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X-ray re-reads in emergency departments
Discusses the Medicare audit focus on emergency department diagnostic imaging interpretations and the related compliance concern in hospital settings.
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Compliance Heads up
Provides a brief compliance-focused summary of the emergency department X-ray interpretation issue highlighted in the work plan.
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OIG targets DME with multiple audits
Covers several durable medical equipment audit topics, including payment oversight, medical necessity, and related modifier review.
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OIG set to look at “Incident-to” PT/OT svcs
Outlines additional planned review areas involving therapy claims, incident-to services, imaging, global surgery periods, and place-of-service coding.
What You Will Learn
- Which broad Medicare billing areas were highlighted in the OIG 2007 work plan
- How the article frames compliance concerns for emergency department imaging interpretations
- What general therapy, DME, imaging, and physician service categories were slated for review
- Which types of claim-editing and documentation issues were part of the discussion
Who Should Read This
- Medical coders
- Compliance officers
- Billing and reimbursement staff
- Physicians
- Emergency department staff
- Radiology practices
- Orthopedic practices
- Therapy providers
- Durable medical equipment suppliers
Modifiers Discussed
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