E/M Coding Alert - 2013 Issue 2
Compliance: Tighten Up Documentation, Correct Modifier Use Or Else, Says OIG
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Article Overview
This article reviews selected items from the OIG’s Compendium of Unimplemented Recommendations and explains why the report matters for compliance-focused providers and coding staff. It highlights scrutiny around global surgery claims, evaluation and management service assumptions, and emergency department diagnostic radiology billing under Medicare Part B. The discussion also covers how CMS and Medicare contractors were urged to respond to identified payment and documentation concerns.
Why This Topic Matters
Providers and coding professionals need awareness of these compliance themes because they affect claim integrity, fee schedule assumptions, and audit exposure in common Medicare billing scenarios.
Article Sections
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OIG compendium overview and global surgery concerns
Introduces the OIG report and summarizes the compliance focus on global surgery payment assumptions and Medicare fee schedule oversight. It also notes CMS responses and related monitoring activity.
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OIG Also Pursuing ED Radiology Services
Describes the OIG’s attention to emergency department diagnostic radiology services and the broader billing concerns raised for Part B claims. It also addresses the request for Medicare contractor analysis support.
What You Will Learn
- How the OIG frames selected unimplemented recommendations affecting Medicare compliance
- Why global surgery claims and evaluation and management assumptions drew audit attention
- What compliance concerns were raised about emergency department diagnostic radiology billing
- How CMS and Medicare contractors were asked to respond to the identified issues
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Physician practices
- Hospital revenue cycle teams
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