Compliance: OIG Sets Sights on Hospital Admissions, Place of Service Coding

Why This Topic Matters

The article helps readers identify billing and documentation areas that may be scrutinized in Medicare audits so they can evaluate whether their internal compliance processes align with current enforcement priorities.

Article Sections

1. Inpatient Admissions Under Fire

   Discusses the OIG’s focus on hospital admission review as part of Medicare compliance oversight. It frames the issue as a documentation and claims audit concern.

2. Differentiate ‘AA’ From ‘QK’ Modifier

   Covers anesthesia reporting as an audit focus and explains that the Work Plan is examining certain modifier usage on claims. The section also addresses broader oversight of medically directed anesthesia services.

3. Know Your Place of Service

   Explains that place of service reporting is a Work Plan target and relates to services performed in different outpatient and office settings. The section emphasizes the importance of accurate claim location reporting.

4. Physical Therapists Should Confirm Medical Necessity

   Summarizes OIG review of outpatient therapy claims and the importance of documentation and medical necessity. It focuses on independent physical therapy services under Medicare rules.

5. Ophthalmologists, Chiropractors Also Under the Microscope

   Notes additional Work Plan attention on ophthalmology and chiropractic claims. The section highlights these as specialty areas subject to Medicare audit review.