OIG releases Work Plan for Fiscal Year 2010
The Office of Inspector General (OIG) of the Department of Health and Human Services has just released its Work Plan for FY 2010. A number of significant issues relating to hospital services covered under Parts A and B are targeted for review. These areas, as identified in the Work Plan, include the following:
- Part A hospital capital payments
- Provider based status for inpatient and outpatient facilities
- Part A inpatient prospective payment system (IPPS) wage indexes
- Hospital payments for nonphysician outpatient services under the IPPS
- Payments to organ procurement organizations
- Inpatient rehabilitation facility admission of patient assessment instruments
- Critical access hospitals
- Medicare disproportionate share payments
- Duplicate graduate medical education payments
- Interrupted stays at inpatient psychiatric facilities payments
- Provider bad debts
- Medicare secondary payer
- Reliability of hospital-reported quality measure data
- Hospital admissions with conditions coded present-on-admission
- Hospital readmissions
- Adverse events: various reviews
- Payments for diagnostic x-rays in hospital emergency departments
- Oversight of hospitals’ compliance with the Emergency Medical Treatment and Labor Act (EMTALA)
- Observations services during outpatient visits
- Coding and documentation changes under the Medicare Severity Diagnosis Related Group (MSDRG) system
- Financial status of hospitals in the New Orleans area
More than half of them focus on the calculation of, with various adjustments to, payment for inpatient services under the IPPS, including whether certain outpatient services provided before or during that stay will be included in the IPPS payment for that stay or will be otherwise payable. OIG proposed review ranges from the appropriateness of the current methodology for calculating the capital payment (which is designed to cover the costs of equipment and facilities) to the reliability of hospital-reported quality measure data, which will determine whether a hospital is entitled to a full or reduced cost-of-living update to its operating payment during a particular fiscal year.
Other areas targeted for review include some of the most complex decisions that hospitals have to make, including the spectrum of care required—outpatient, outpatient observation and inpatient–and the appropriateness of specific admissions and discharges.
Hospitals are encouraged to review the Work Plan carefully and to follow the OIG’s ongoing activities as they conduct related audits and report the results of those audits. At the same time, hospitals should begin to proactively review their own operations in the targeted areas to identify any issues that need to be addressed sooner, rather than later.
About the Author: Judith Kares is an instructor for HCPro's Medicare Boot Camp - Hospital Version. Judith has also been involved in the following:
