Medical review: These OIG Recommendations May Make Life Harder

Why This Topic Matters

The article highlights proposed and planned changes that may affect how durable medical equipment claims are reviewed and documented under Medicare oversight. It is useful for stakeholders who need to monitor payer compliance expectations and contractor review practices.

Article Sections

1. CMS response to OIG recommendations

   Summarizes the agency’s reaction to recommendations intended to strengthen review of durable medical equipment payment errors and contractor processes.

2. Expanded documentation and medical record review

   Covers proposed changes to the scope of documentation and records reviewed during medical necessity determinations.

3. Clinical inference and written guidance

   Addresses policy and training issues related to how reviewers apply clinical inference within the review process.

4. Oral guidance and documentation consistency

   Discusses the need to align informal guidance with written policy and program documents.

5. Provider training on documentation

   Notes recommendations involving additional education for physicians and other providers on documenting support for ordered items.

6. Beneficiary contact for high-risk claims

   Describes planned testing of beneficiary interviews as part of expanded review procedures for selected high-risk durable medical equipment items.