Compliance: OIG to Focus on E/M, Incident-to, and Global Modifiers in 2013

Why This Topic Matters

The article helps practices identify claim areas likely to draw audit attention and understand the general compliance themes emphasized by OIG for the year. It is relevant for organizations that bill Medicare Part B services and want to prioritize internal review and documentation oversight.

Article Sections

1. Potentially Inappropriate E/M Payments and 'Identical Documentation'

   Summarizes the planned review focus on evaluation and management claims and documentation patterns. It also notes attention to electronic health record concerns and cloned notes across services.

2. Incident to services

   Covers the planned review of incident-to billing and related compliance concerns. The section discusses general documentation and supervision themes tied to this service category.

3. Payment for 'G' modifiers with ABN

   Describes the planned review of claims that include certain denial-related modifiers and their use alongside advance beneficiary notice practices. The emphasis is on Medicare payment review and compliance risk.

4. Use of Modifiers During Global Period

   Addresses OIG attention to modifier use during the global surgery period. The section focuses on broad compliance scrutiny around separately payable services during the global period.

5. Other issues

   Lists additional service areas expected to receive review attention, including several outpatient and specialty topics. It provides a broader view of the remaining subjects mentioned in the Work Plan.