OIG

Why This Topic Matters

Practices can use this overview to identify documentation and billing workflows that may draw audit attention. It is especially useful for billing staff, coders, compliance personnel, and physicians who want to monitor risk areas tied to Medicare claims processing and supporting records.

Article Sections

1. Medical necessity of diagnostic tests

   This section addresses scrutiny of diagnostic testing documentation and related Medicare payment concerns. It focuses on the broader compliance issues around test ordering and support for services performed by physicians.

2. Incident to

   This section discusses billing and supervision considerations for incident-to services and supplies. It covers the operational context for office-based services performed under physician oversight.

3. CMNs

   This section covers certificate-of-medical-necessity documentation for durable medical equipment. It emphasizes the need for complete records supporting ordered items and physician review.

4. National Correct Coding Initiative (CCI) modifiers

   This section discusses review activity involving modifier use in the context of National Correct Coding Initiative edits. It focuses on compliance oversight related to claims processing and payment accuracy.