Compliance: OIG to Focus on Incident-to Claims, E/M Services, And More in 2012

Why This Topic Matters

Understanding the OIG’s planned review areas can help organizations prioritize compliance efforts, reduce exposure to claim denials or overpayments, and prepare for audit risk in key outpatient and physician billing scenarios.

Article Sections

1. Incident-to services

   Discusses the OIG’s review interest in incident-to billing and the broader compliance considerations tied to this type of service. The section also touches on how these services relate to medical record review and program oversight.

2. Compliance with assignment rules

   Covers Medicare assignment-related compliance and the OIG’s focus on beneficiary billing concerns. The section frames the topic as a payment integrity and patient balance issue.

3. Trends in E/M coding

   Summarizes planned review activity involving evaluation and management claims and patterns in physician billing. It also addresses E/M services furnished during global surgical periods and related modifier usage.

4. Payment for 'G' modifiers with ABN

   Introduces the OIG’s interest in claims involving ABN-related modifier use and Medicare payment patterns. The section references a group of related modifiers without detailing their individual meanings.

5. Hospital observation services

   Focuses on outpatient observation claims and the compliance concerns associated with their use. The section also notes that CMS guidance may affect how observation services are coded and reviewed.