2008 OIG Plan

The 2008 OIG (Office of the Inspector General) Plan lists the following regulations that will be scrutinized:

1. Place of Service Codes- Because services done in the physician's office are paid at a higher rate, the OIG will check to be sure that each service billed was actually provided in the correct facility.

2. E/M During Global Surgery Periods- Medicare states "We will review industry practices related to the number of evaluation and management (E/M) services provided by the physician and reimbursed as part of the global surgery fee. CMS's Medicare Claims Processing Manual, Chapter 12, section 40, contains the criteria for the global surgery policy. Under the global surgery fee concept, physicians bill a single fee for all of their services usually associated with a surgical procedure and related to E/M services provided during the global surgery period. The global surgery fee includes payment for a certain number of E/M services provided during the global surgery period. We will determine whether industry practices related to the number of E/ M services provided during the global surgery period have changed since the global surgery fee concept was developed in 1992."

3. Medicare Payment for Selected Physician Services- The OIG will determine if payments were correctly made for physician services such as surgery, consultations, and home, office and institutional calls.

4. Incident To Services- Services billed incident to by physicians for their professional services, as well as, the qualifications and appropriateness of non-physician staff performing them, will be a target in 2008. They will also review records for medical necessity and documentation of the quality of care.

5. Appropriateness of Mediare Payments for Polysomnography- The OIG will review weither or not this test was necessary.

6. Assignment Rules by Medicare Providers- The OIG will reivew Medicare providers practices to ensure that assingment rules for billing Medicare beneficiaries are followed.

7. Medicare Payments of Interventional Pain Management- The OIG will determine the appropriateness of Interventional Pain Management procedures.

Contact MSO Solutions, LLC Today and we will help you establish an auditing program specific to your practice and specialty!!

www.msosolutions.com
315.701.5821


References:
2008 OIG Plan: Put Away Your Crystal Ball and Take a Look at the Future.
By: Rhonda Buckholz, CPC
AAPC Coding Edge
December 2008