E/M Coding Alert - 2003 Issue 8
FRAUD & ABUSE: OIG Heats Up Griddle the Carriers Make You Dance On
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Article Overview
This article discusses how the HHS Office of Inspector General’s Work Plan can shape Medicare carrier audit focus and affect physician billing scrutiny. It is aimed at coders, compliance professionals, and physicians who want to understand the broad areas that tend to attract review, including evaluation and management services, consultation services, dialysis-related billing, ambulatory surgery center relationships, incident-to billing, and other carrier audit concerns. The piece also frames why comparing billing patterns against national norms can matter in an audit environment.
Why This Topic Matters
It helps readers understand why certain billing patterns may attract payer attention and how audit priorities can shift based on national utilization trends and compliance concerns.
Article Sections
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OIG Work Plan and carrier audit priorities
Introduces the role of the HHS Office of Inspector General Work Plan in shaping audit focus and carrier scrutiny. It explains the general relationship between Medicare, carriers, and areas selected for review.
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Areas of physician billing concern
Summarizes the broad categories of physician services and arrangements identified as audit concerns. The section covers utilization patterns, service types, and compliance topics across physician billing.
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Comparison to national norms and audit risk
Discusses how billing patterns that differ from national averages may draw attention. It also addresses the broader importance of documentation and consistency in supporting claims.
What You Will Learn
- How OIG Work Plan priorities can influence audit focus
- Which broad physician billing areas are commonly scrutinized
- Why unusual billing patterns may attract payer review
- How national utilization comparisons can inform compliance awareness
Who Should Read This
- Physician coders
- Compliance staff
- Practice managers
- Physicians
- Billing professionals
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