decisionhealth Newsletters, Part B News - 2008 Issue 10 (October)
OIG zeroes in on practice expense, modifiers in 2009 work plan
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Article Overview
This article summarizes selected items from the HHS Office of Inspector General’s Fiscal Year 2009 Work Plan and explains why providers, laboratories, drug suppliers, and Medicare Advantage organizations should pay attention. It highlights broad audit and enforcement focus areas involving physician claims, laboratory billing patterns, Part B drug payment issues, and Medicare Advantage payment and administration topics. The article is intended for coding, billing, compliance, and reimbursement professionals who want to understand where scrutiny may increase and which categories of claims and operations are being reviewed.
Why This Topic Matters
The Work Plan signals areas where Medicare claims and plan operations may be audited more closely, making it important for compliance teams, coders, and billing staff to monitor documentation, billing patterns, and payment-related processes.
Article Sections
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Physicians and other health professionals
Covers physician and related professional service areas identified for review in the work plan, including claims, documentation, and selected billing patterns.
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Part B drug payments
Discusses Part B drug payment topics and data-related issues that the work plan says will be examined by OIG.
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Medicare Advantage (MA) plans
Summarizes Medicare Advantage oversight areas in the work plan, including payment, reporting, rebate, and appeals-related topics.
What You Will Learn
- What broad categories of physician, laboratory, drug, and Medicare Advantage issues appear in the 2009 OIG Work Plan.
- Why the work plan is relevant to compliance and billing oversight.
- Which general types of Medicare payment and claims areas are receiving attention from OIG.
- How the article frames the significance of recurring and newly added work plan topics.
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Healthcare auditors
- Reimbursement professionals
Codes Discussed
Modifiers Discussed
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