Most organizations base annual internal compliance plan audits on the Office of Inspector General’s (“OIG”) Work Plan. Completing reviews as outlined in the OIG 2012 Work Plan that are specific to your organization will require precision and expertise. The 2012 plan has so much detail that most providers will have to set aside additional time and resources to successfully perform the necessary reviews.
Hospitals should prepare for a multitude of reviews regarding:
- Hospital Reporting of Adverse Events
- Reliability of Hospital-Reported Quality Measure Data
- Conditions Coded at the Time of Admission
- Accuracy of Present-on-Admission Indicators Submitted on Medicare Claims
- Medicare Inpatient and Outpatient Payments to Acute Care Hospitals
- Hospital Inpatient Outlier Payments or Claims with High or Excessive Payments
- Hospital Same-Day Readmissions Claims
- Acute-Care Hospital Inpatient Transfers to Inpatient Hospice Care
- Non-Inpatient Prospective Payment System & Hospital Payments for Non-Physician Outpatient Services
- Observation Services During Outpatient Visits
Physicians should prepare for Evaluation & Management (“E/M”) Services Reviews on:
- Trends in Coding of E/M services from 2000-2009 that indicate questionable E/M service billing
- E/M Services Provided During Global Surgery Periods
- Use of Modifiers During the Global Surgery Period
- Review of Potentially Inappropriate Payments
For more information about how to prepare your organization for the OIG 2012 Work Plan, contact the experts listed below at PYA, (800) 270-9629.
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