Compliance: OIG to Focus on Incident-to Claims, E/M Services, And More in 2012

Why This Topic Matters

Knowing the OIG’s work plan focus areas helps practices and billing teams anticipate compliance risk, review internal processes, and identify documentation or billing areas that may deserve closer attention.

Article Sections

1. Incident-to services

   Discusses the OIG’s planned review area involving office-based services reported under incident-to rules and the compliance concerns associated with them.

2. Compliance with assignment rules

   Covers Medicare assignment-related billing compliance and the agency’s interest in beneficiary billing above allowed amounts.

3. Trends in E/M coding

   Summarizes the planned review of evaluation and management billing patterns, including activity during global surgery periods and related modifier use.

4. Payment for 'G' modifiers with ABN

   Describes OIG scrutiny of claims involving Medicare denial-related modifier reporting and advance beneficiary notice use.

5. Hospital observation services

   Addresses outpatient observation service claims and the CMS guidance context referenced for observation coding.