12/17/2010       2011 OIG Work Plan for Physicians                     LAN                     RKP                     WO ...
12/17/2010                                                                       2011 OIG WORKPLAN FOR PHYSICIANSOIG WORKP...
12/17/2010                                                      2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLI...
12/17/2010                                                              2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AN...
12/17/2010                                                             2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND...
12/17/2010                                                                               2011 OIG WORKPLAN FOR PHYSICIANSO...
12/17/2010                                               2011 OIG WORKPLAN FOR PHYSICIANSDEMONSTRATE COMPLIANCE• Document ...
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2011 OIG workplan for physicians

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2011 OIG workplan for physicians

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2011 OIG workplan for physicians

  1. 1. 12/17/2010 2011 OIG Work Plan for Physicians LAN RKP WO G OI 11 20 INCREASING REVENUES IN THE BUSINESS OFFICEPresented by Jennifer Hume, CPC, CPMA, CEMC Richard S. Blauvelt, BA, MHSM President/CEO PRO-DOC SOLUTIONS 2011 OIG WORKPLAN FOR PHYSICIANS OIG WORKPLAN • Released on October 1 of each year • Coincides with the start of the new fiscal year for the government • Lists key investigative priorities. • Multiple “parts” -Part 1 addresses Medicare Part A and Part B services. 2 1
  2. 2. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSOIG WORKPLAN—PART 1 Addresses many different provider types Provider Types Home Health Hospitals Nursing Facilities Agencies Other Providers & Medical Equipment Part B Payments for Suppliers & Supplies Prescription Drugs Medicare Part A and Part B Contractor Operations3 2011 OIG WORKPLAN FOR PHYSICIANSOIG WORKPLAN—PART 1• Evaluation and Management Services• Diagnostic Testing• Medicare Program – General• Medical Necessity• Comprehensive Error Rate Testing4 2
  3. 3. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIESEvaluation and Management Services • Coding of E/M services • Payments for E/M services • E/M services during global surgery periods5 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIESDiagnostic Testing • Appropriatness of Medicare payments for polysomnography • Medicare payments for sleep testing • Excessive payments for diagnostic tests • Medicare payments for Part B imaging services6 3
  4. 4. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIERSMedicare Program – General • Medicare providers’ compliance with assignment rules • Payments for services ordered or referred by excluded providers • Medicare services billed with dates of service after beneficiary’s date of death • Place of service errors7 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIERSMedical Necessity • Medicare payments for claims deemed not reasonable and necessary • Medicare billings with modifier GY8 4
  5. 5. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIERSComprehensive Error Rate Testing • Comprehensive Error Rate Testing (CERT) Program: FY2010 error rate oversight • Error-prone providers: Medicare Part A and Part B9 2011 OIG WORKPLAN FOR PHYSICIANSOTHER PROVIDERS AND SUPPLIESProviders other than physicians Therapists Hospice Independent Diagnostic Comprehensive Outpatient Testing Facilities (IDTFs) Rehabilitation Facilities (CORF) Portable x-ray suppliers Clinical laboratories ESRD services Clinical Social Workers Ambulatory surgery centers Partial Hospitalization Services10 5
  6. 6. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSOTHER WORKPLAN PARTSDon’t limit workplan reviews to just the other providers and supplierssection • Hospital: Medicare Secondary Payer/Other Insurance Coverage: We will review Medicare payments for beneficiaries who have other insurance. Pursuant to the Social Security Act, § 1862(b), Medicare payments for such beneficiaries are required to be secondary to certain types of insurance coverage. We will assess the effectiveness of procedures in preventing inappropriate Medicare payments for beneficiaries with other insurance coverage. For example, we will evaluate procedures for identifying and resolving credit balance situations, which occur when payments from Medicare and other insurers exceed the providers’ charges or the allowed amounts. (OAS; W‐00‐11‐35317; various reviews; expected issue date: FY 2011; new start)11 2011 OIG WORKPLAN FOR PHYSICIANSHOW TO USE THE WORKPLAN• Review when issued• Identify key investigative priorities that may affect your practice• Incorporate into your annual compliance audit plan Example: General surgical practice and E/M services during the global surgical package12 6
  7. 7. 12/17/2010 2011 OIG WORKPLAN FOR PHYSICIANSDEMONSTRATE COMPLIANCE• Document your efforts• Identify issues and take corrective action• Document —Issue —Findings —Corrective actions —Resolution13 2011 OIG WORKPLAN FOR PHYSICIANSQUESTIONS Thank you for attending!14 7

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