Outpatient Facility Coding Alert - 2014 Issue 5
Compliance: Consider These Additional OIG Hotspots This Year
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Article Overview
This article reviews additional compliance topics identified in the 2014 Office of Inspector General Work Plan beyond routine E/M and place of service issues. It is intended for coders, compliance staff, auditors, and billing professionals who want a high-level view of the government’s focus areas across multiple specialties and service types, including chiropractic, radiology, electrodiagnostic testing, laboratory services, ophthalmology, and physical therapy. The article discusses the general categories of concern raised in the Work Plan and why they matter for Medicare billing oversight.
Why This Topic Matters
Healthcare billing teams use OIG Work Plan priorities to anticipate audit focus and review documentation and claims processes in higher-risk service areas.
Article Sections
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2014 OIG Work Plan Topics
An overview of the compliance areas highlighted in the 2014 Work Plan and the broader Medicare billing context for Part B practices.
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Chiropractic Services
A discussion of chiropractic billing as an OIG focus area and the types of issues the agency planned to examine.
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Big-Ticket Radiology Services
A summary of radiology-related oversight concerns involving diagnostic services and payment review.
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Electrodiagnostic Testing
Coverage of electrodiagnostic testing as a Work Plan topic and the utilization patterns under review.
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Lab Tests
A brief discussion of laboratory service payments and the OIG’s interest in possible questionable billing patterns.
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Ophthalmology Billing
An overview of ophthalmology-related billing concerns and the possibility of geographic variation in claims patterns.
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Physical Therapy
A review of outpatient physical therapy as a compliance focus area and the documentation and medical necessity concerns under review.
What You Will Learn
- Which broad Medicare service categories were identified as OIG compliance priorities
- How the article frames provider- and specialty-specific billing review areas
- Why documentation, medical necessity, and payment oversight are central themes in the Work Plan
- Which types of services were highlighted for further government scrutiny
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Practice managers
- Auditors
- Revenue cycle professionals
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