ED Coding & Reimbursement Alert - 2015 Issue 44
Compliance: OIG Recovered $3.35 Billion in 2015, Plans Scrutiny of Ophthalmology Services
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Article Overview
This article reviews an OIG Semiannual Report to Congress and highlights major Medicare recovery totals, compliance concerns, and targeted oversight areas. It discusses broad billing integrity issues affecting chiropractic services, ophthalmology services, and place-of-service coding, and explains why providers should pay attention to audit and payment integrity trends. The piece is relevant to compliance staff, coders, billers, auditors, and practice administrators monitoring Medicare risk areas and self-audit priorities.
Why This Topic Matters
The article helps providers understand where federal oversight is focusing and why billing accuracy matters for Medicare compliance and audit risk. It is useful for organizations evaluating internal billing controls, self-audits, and specialty-specific scrutiny trends.
Article Sections
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OIG recovery totals and semiannual report overview
Summarizes the report’s overall recovery activity and the agency’s emphasis on identifying improper payments early. It frames the compliance context for the rest of the article.
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Examples of recoveries and scrutiny areas
Reviews selected areas highlighted in the report, including specialty billing concerns and place-of-service issues. The section presents the broad compliance themes that prompted further monitoring.
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Compliance takeaway for Medicare billing
Closes with a general reminder to review billing practices and perform internal audits. It emphasizes the importance of accurate reporting in light of increased oversight.
What You Will Learn
- How the OIG framed its Medicare recovery and oversight activity
- Which broad service areas were highlighted as compliance concerns
- Why place-of-service accuracy and self-audits are emphasized in the article
- How the report’s findings relate to Medicare billing oversight trends
Who Should Read This
- Medical coders
- Medical billers
- Compliance officers
- Practice administrators
- Auditors
- Healthcare revenue cycle staff
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