Outpatient Facility Coding Alert - 2015 Issue 41
Compliance: OIG to Scrutinize Prolonged Services, Home Visits and More in 2016
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Article Overview
This article summarizes selected 2016 Office of Inspector General Work Plan topics that may affect Medicare billing, documentation, and audit preparedness. It is aimed at coders, compliance staff, and practices that report evaluation and management-related services, home visits, anesthesia, chiropractic care, portable x-rays, and outpatient therapy. The piece explains the general areas under review and emphasizes documentation and medical necessity themes without serving as a coding reference.
Why This Topic Matters
It helps readers identify which Medicare service categories were being targeted for review in 2016 and understand the broad compliance and documentation issues likely to draw audit attention.
Article Sections
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Prolonged Services Under Fire
Discusses the planned review focus on prolonged services and the documentation concerns associated with those claims. It also references new prolonged-services-related code updates in the CPT 2016 context.
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Watch Your Home Visits
Covers the planned review of home visit services and the broader documentation themes tied to medical necessity and place-of-service considerations. The section also points readers to Medicare manual language relevant to home-visit documentation.
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Some Issues Carry Over From 2015
Summarizes other audit topics that continue from the prior year, including anesthesia, chiropractic services, portable x-rays, and outpatient physical therapy.
What You Will Learn
- Which Medicare service areas were highlighted in the OIG’s 2016 Work Plan
- What broad documentation themes are emphasized for audit readiness
- Which categories of services were already under continued scrutiny from prior years
- How the article frames compliance concerns for practices reporting home visits and prolonged services
Who Should Read This
- Medical coders
- Compliance officers
- Billing staff
- Physicians and group practices
- Health care administrators
Codes Discussed
Code Ranges Discussed
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