Compliance: OIG to Focus on Incident-to Services, Ultrasounds, Unlisted Procedures, And More in 2009

Why This Topic Matters

Understanding the OIG’s annual Work Plan helps healthcare organizations identify compliance areas that may draw audit scrutiny and prepare documentation and billing processes accordingly. This article is relevant for teams responsible for Medicare billing integrity and internal compliance monitoring.

Article Sections

1. Work Plan overview

   Introduces the OIG’s annual Work Plan and explains its role in signaling audit and review priorities. It also frames the article’s focus on Medicare claims oversight.

2. Unlisted Procedures Under Fire

   Discusses OIG attention to procedure reporting for services not listed in HCPCS. The section addresses the broader compliance concern surrounding use of unlisted procedures.

3. Modifier GY On Hot Seat

   Covers OIG review of claims involving modifier use and related Medicare coverage issues. It also references beneficiary notice considerations in the context of excluded services.

4. OIG Reviews Ultrasounds

   Describes OIG interest in high-volume ultrasound billing and medical necessity review. The section focuses on utilization patterns and provider profiles.

5. Incident-to on the Radar

   Summarizes OIG attention to incident-to services and nonphysician practitioner involvement. It emphasizes documentation and qualifications as general oversight themes.