COMPLIANCE: OIG Intends to Hone in on Modifier GY Claims, POS Errors, and More in 2010

Why This Topic Matters

Providers, coders, and billing staff can use this article to understand where federal review activity may increase and which general claims workflows deserve attention. It is especially useful for organizations that submit Medicare claims or participate in incentive programs.

Article Sections

1. What the OIG Work Plan is

   Introduces the OIG Work Plan and the offices involved in carrying out the agency's annual review agenda. Explains the general purpose of the plan as a signal of likely audit and oversight activity.

2. What will the OIG review?

   Describes the article's main review categories and the compliance concerns associated with them. Provides context for why providers may want to examine internal claims processes in advance of review activity.

3. X-Rays in EDs Under Fire

   Summarizes the planned review of hospital emergency department imaging-related claims and records. Focuses on Medicare Part B outpatient payment oversight in this setting.

4. Modifier GY Under Microscope

   Covers the planned review of claims involving a specific Medicare modifier and discusses broader concerns about excluded services and related billing patterns. Notes that the OIG is looking at trends in provider and supplier usage.

5. E-Prescribing Pay Scrutinized

   Explains the planned review of incentive payments connected with e-prescribing activity. Addresses the OIG's interest in whether payments were made correctly and how any overpayments may have been handled.