Place of service, reassignment pop up on OIG's radar

Why This Topic Matters

The article helps healthcare stakeholders understand where federal scrutiny is expected to increase and which billing and documentation areas may draw review. That makes it useful for compliance planning, internal audits, and staying aware of Medicare oversight priorities.

Article Sections

1. OIG’s 2007 work plan overview

   Introduces the OIG work plan and the general return to more active scrutiny of physician billing issues. It frames the article’s focus on Medicare oversight priorities for the year.

2. Physician and drug billing-related highlights

   Summarizes the major physician and drug billing topics included in the work plan. The section provides a broad view of the subject areas targeted for review.

3. Medicare’s assignment rules

   Covers the planned review of billing practices related to Medicare assignment and beneficiary billing awareness. It addresses compliance oversight in the physician payment setting.

4. Use of imaging services in physician offices

   Discusses planned scrutiny of imaging growth and billing patterns in office settings. It places the issue in the context of broader Medicare payment oversight.

5. Polysomnography tests

   Notes the planned review of billing for sleep studies and related payment trends. The section focuses on a specific diagnostic service area.

6. Pathology services

   Addresses the review of pathology spending in physician offices and relationships with outside pathology companies. It reflects concern about office-based service arrangements.

7. Eye surgery

   Covers planned review of billing for cataract and laser eye surgery, including controls intended to prevent improper payments. The section centers on ophthalmic surgical services.

8. Billing services

   Describes continued review of how billing company relationships may affect claim submission and reimbursement. It emphasizes the administrative side of medical billing.

9. Cardiography/echocardiography

   Discusses review of billing for technical and professional components of cardiac diagnostic services. The section focuses on accurate component-based billing.

10. “Welcome to Medicare” exam payment

    Examines the preventive visit benefit and its effect on billing and Medicare spending. It considers payment policy questions around the initial preventive exam.

11. Mental health

    Summarizes planned review of medical necessity for mental health services in physician offices. The section addresses service-setting utilization within Medicare.

12. Wound care

    Describes planned review of wound care services for medical necessity and Medicare compliance. It also notes attention to carrier payment controls.

13. PT/OT services

    Covers continued oversight of therapy services, including documentation and physician certification issues. The section highlights compliance concerns for rehabilitation billing.

14. Botox treatments

    Notes an audit focus on covered Botox treatment claims and potential billing abuse. The section addresses a specific injectable therapy area.

15. IVIG

    Discusses reimbursement and availability concerns for intravenous immune globulin and related payment review. The section focuses on physician-office administration issues.

16. Appeals

    Reviews the planned update on the Medicare appeals process and related administrative changes. It addresses system performance and case processing concerns.