E/M Coding Alert - 2016 Issue 38
Compliance: OIG to Address Issues in Care Management, Prolonged Services, and More in 2017
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Article Overview
This article summarizes key items from the OIG’s 2017 Work Plan that are relevant to Medicare billing and compliance. It discusses broad oversight themes such as care management services, prolonged services, anesthesia-related review, therapy and chiropractic services, lab test payment oversight, and scrutiny of financial relationships under federal program integrity initiatives. The piece is aimed at providers, coders, compliance staff, and revenue cycle teams who need to understand which service areas were under review and why they matter for documentation and compliance planning.
Why This Topic Matters
It helps readers identify which billing and compliance areas the OIG highlighted for review in 2017 so they can assess internal documentation, reporting, and audit readiness.
Article Sections
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Work Plan Overview
Introduces the OIG Work Plan and explains its role in outlining areas of review for the fiscal year. Sets the context for the compliance topics addressed in the article.
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Watch Your Financial Relationships
Summarizes the article’s discussion of federal oversight involving provider-supplier relationships, payment transparency, and related compliance concerns. References the broader program integrity context tied to these reviews.
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What’s Not Covered Under Care Management
Covers the article’s discussion of chronic care and transitional care management as compliance focus areas. Addresses the general scope of care management services reviewed by the OIG.
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Here Are a Few Other Quick Takeaways
Highlights additional service categories and review topics mentioned in the Work Plan, including anesthesia, therapy, chiropractic care, prolonged services, and laboratory testing. Also notes the article’s emphasis on broader compliance monitoring.
What You Will Learn
- How the OIG’s annual Work Plan highlights compliance priorities for Medicare-related services
- Which broad service categories were flagged for increased scrutiny in 2017
- Why care management and prolonged services were important review areas
- How financial relationship oversight fits into federal compliance monitoring
- What general types of laboratory and service-payment issues were included in the Work Plan
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Physician practices
- Revenue cycle teams
- Healthcare administrators
Codes Discussed
Code Ranges Discussed
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