1 / 30

The OIG Work Plan

The OIG Work Plan. The 2013 OIG Work Plan. OIG Work Plan. OIG Work Plan. OIG investigative objectives for healthcare provider :. OIG Work Plan. OIG Work Plan. OIG Work Plan. Provider Based Policies. Outpatient PPS. Outpatient PPS (continued). Consider. . . Outpatient PPS .

quynh
Download Presentation

The OIG Work Plan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The OIG Work Plan The 2013 OIG Work Plan

  2. OIG Work Plan

  3. OIG Work Plan • OIG investigative objectives for healthcare provider :

  4. OIG Work Plan

  5. OIG Work Plan

  6. OIG Work Plan

  7. Provider Based Policies

  8. Outpatient PPS

  9. Outpatient PPS (continued) Consider. . .

  10. Outpatient PPS

  11. Outpatient PPS Consider. . .

  12. Outliers

  13. Outliers Consider. . .

  14. Never Events or Present on Admission

  15. Medical Devices- Warranty and Replacements

  16. Medical Devices- Warranty and Replacements

  17. Dental Services

  18. Physicians -Place of Service (POS) Errors

  19. Physicians - “Incident to” Services

  20. Evaluation and Management Services:Aberrant Billing Patterns

  21. E/M Services • EHR “Cloning” - Medicare contractors have noted an increased frequency of medical records with identical documentation across services. Issue • Copy and paste functionality • Consider limiting ability to pull previous information forward or at least limiting where the info may be placed • Medical necessity • Per Medicare IOM 100-04 Chapter 12 § 30.6.1: • “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. “ Consider

  22. Diagnostic radiology

  23. Personally Preformed Anesthesia Services

  24. Nerve conduction Testing

  25. Other OIG Concerns

  26. 2013 OIG Work Plan

  27. The Work Plan as a Tool

  28. Working with the OIG Work Plan

  29. Questions or Comments?

  30. Contact Today’s Speakers. . . Presented by Maggie Fortin, CPC, CPC-H, CHC Ext. 7547 Mfortin@bnncpa.com BAKER | NEWMAN| NOYES 280 Fore Street Portland, ME 04101 1-800-244-7444 www.bnncpa.com

More Related