decisionhealth Newsletters, Coder Pink Sheets - 2010 Issue 11 (November)
Work Plan 2011: E/M services, ABN use under the microscope
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Article Overview
This article summarizes selected items from the HHS Office of Inspector General’s 2011 Work Plan that are relevant to Medicare compliance and medical coding. It highlights the general categories of review the agency planned to focus on, including evaluation and management services, Medicare billing oversight, claims handling by contractors, and appeal processes. The piece is useful for coders, compliance staff, billers, and practice managers who want a broad view of upcoming audit and oversight priorities.
Why This Topic Matters
It helps readers identify which broad Medicare compliance areas were on the OIG’s radar for 2011 and understand where increased scrutiny could affect documentation, claims processing, and contractor activity.
Article Sections
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Work Plan highlights for providers
Summarizes the main provider-focused review areas identified in the 2011 Work Plan, with emphasis on evaluation and management services and other Medicare payment oversight topics.
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Carriers and ALJs also targeted
Covers Work Plan items aimed at Medicare contractors and administrative review activity, including coverage determinations and appeal processes.
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Editor's note
Contains publication and webinar promotion information related to the Work Plan topic.
What You Will Learn
- Which broad Medicare compliance areas the OIG planned to examine in 2011
- How the Work Plan grouped provider billing topics and contractor oversight topics
- What kinds of audit and review areas were highlighted for evaluation and management services
- Why Medicare appeal processes and coverage determinations were included in the Work Plan
- How the article frames the relevance of the Work Plan for compliance monitoring
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
- Revenue cycle professionals
- Medicare-focused providers
Codes Discussed
Modifiers Discussed
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