Compliance: Know What The OIG Will Be Targeting

Why This Topic Matters

It helps coders, billers, compliance staff, and providers understand which claim patterns are being watched and what general documentation and coding topics are being examined in the current Work Plan.

Article Sections

1. Documentation vulnerabilities under the Work Plan

   Introduces the Work Plan focus on documentation integrity and medical record concerns across Medicare claims. The section frames the article’s compliance context and the kinds of records likely to be reviewed.

2. E/M services under fire

   Discusses evaluation and management services as a target area and describes broad concerns about medical record consistency. It also addresses the role of electronic records and record-keeping practices in compliance reviews.

3. Differentiate ‘AA’ from ‘QK’ modifier

   Covers anesthesia reporting as another audit focus and outlines the general distinction between personally performed and medically directed services. The section also references related anesthesia modifier usage.

4. Know your place of service

   Reviews place-of-service coding as a Medicare compliance issue, especially for services performed outside the office setting. The section emphasizes checking where services occurred before claim submission.