E/M Coding Alert - 2015 Issue 21
Compliance: OIG Launches Review of IMRT, Laboratory Claims
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Article Overview
This compliance-focused article explains an updated OIG Work Plan and highlights the types of Part B provider claims and operational areas now under review. It is relevant to medical coders, billing staff, compliance teams, radiation oncology practices, laboratory services, and organizations using EHRs within ACOs. The article discusses broad oversight themes such as claim accuracy, Medicare payment analysis, and health information exchange, along with the code references tied to radiation therapy billing.
Why This Topic Matters
Readers can use this article to understand which compliance areas the OIG is prioritizing and to gauge whether their billing, laboratory, or care-coordination processes may be affected by current audit focus.
Article Sections
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Latest Work Plan update reveals new audit areas
Introduces the Work Plan update and summarizes the categories of provider issues added for review. It frames the article’s focus on Medicare-related compliance and audit activity.
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Focus on IMRT accuracy
Covers the radiation oncology audit focus and discusses coding-related changes affecting IMRT reporting in different care settings. The section also references guidance from a professional society document.
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Button Up Lab Claims
Summarizes the laboratory payment review topic and the broader Medicare payment analysis affecting clinical diagnostic lab tests. It also notes prior audit concerns in higher-complexity laboratory environments.
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ACOs Should Be Sharing EHRs
Describes the Work Plan attention on ACO use of electronic health records and interoperability-related care coordination goals. The section focuses on health information exchange and operational use of EHR systems.
What You Will Learn
- Which compliance areas were added to the OIG Work Plan update
- How the article frames Medicare oversight of radiation oncology claims
- What broad laboratory payment and audit themes are discussed
- Why EHR use and interoperability are being reviewed in ACO settings
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Radiation oncology practices
- Clinical laboratory managers
- ACO administrators
- Healthcare auditors
Codes Discussed
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