Outpatient Facility Coding Alert - 2013 Issue 3
Practice Management: Get Ready For OIG Scrutiny of Modifiers and More
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Article Overview
This practice management article explains several 2013 OIG audit priorities relevant to general surgery practices. It covers documentation review themes, incident-to services, modifier-related payment scrutiny, global period concerns, and place-of-service reporting. The piece is useful for coders, billers, auditors, and practice managers who want to understand where Medicare oversight was expected to concentrate and what broad areas of claim review may matter to compliance efforts.
Why This Topic Matters
The article helps readers identify billing and documentation areas that were under expected Medicare audit attention so they can assess internal compliance risks and prepare for review.
Article Sections
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Potentially Inappropriate E/M Payments and ‘Identical Documentation’
Discusses OIG attention to evaluation and management documentation patterns and broader concerns about copied or cloned records in medical review.
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Incident-to Services
Summarizes OIG interest in incident-to billing and the compliance risks associated with services that may not be visible in claims data.
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Payment for ‘G’ modifiers with ABN
Covers OIG review of Medicare claims involving certain modifiers and their relationship to advance beneficiary notice-related billing.
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Use of Modifiers During Global Period
Addresses scrutiny of modifier use during the global surgery period and the potential for inappropriate payment associated with those claims.
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Errors in Place of Service Reporting
Reviews expected OIG focus on place-of-service coding and payment differences between facility and non-facility settings.
What You Will Learn
- Which general billing and documentation areas were highlighted in the 2013 OIG work plan
- How audit attention may affect evaluation and management documentation review
- Why incident-to services and modifier-related claims can draw scrutiny
- What types of place-of-service reporting issues were identified as compliance concerns
Who Should Read This
- General surgeons
- Medical coders
- Medical billers
- Practice managers
- Compliance staff
- Medical auditors
Modifiers Discussed
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