It’s the time of year again to carefully review your compliance with Medicare requirements. The 2012 Office of Inspector General (OIG) Work Plan will focus on physician compliance and identifying improper payments.
Understanding the projects in the work plan and OIG’s priorities for 2012 could help you avoid future issues with reimbursement.
During 2012, the OIG will be reviewing activities such as:
- Compliance with assignment rules and inappropriate beneficiary billing
- Physicians’ Medicare opt-out data, including non-participating claims data, regional opt-out rates, and potential impacts on access to care
- Evaluation and management (E/M) claims trends and “questionable billing”
- Industry practice related to the number of E/M services as part of the global surgery fee
- Appropriate use of certain claims modifier codes during the global surgery period
- Potentially inappropriate payments for E/M services and multiple E/M services for the same providers and beneficiaries
- Potentially duplicative Medicare payments for high-cost diagnostic radiology tests
- Pricing and utilization under the new bundled End Stage Renal Disease Prospective Payment System (ESRD PPS)
- Payment system controls that identify high cumulative Medicare Part B payments to physicians and suppliers
- Physician billing for “incident to” services to determine whether there is a higher error rate than non-incident to services
The Department of Health and Human Services OIG is the federal agency responsible for protecting the Medicare program from fraud and abuse. Each year, the OIG issues a work plan that provides a brief description of activities that it plans to initiate or continue in the coming year.