October 12, 2009 | Debbie Mackaman | Comments 0
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Recent OIG Reports and Medical Review Implications

In last week’s post, we looked at the OIG Work Plan for Fiscal Year 2010. There were many issues listed for both Part A and Part B that will be on the radar for a targeted review. Hospitals are encouraged to closely examine the OIG Work Plan as part of their annual compliance program review process.

In addition, reviewing OIG audits can help hospitals and physicians identify some challenging areas within their own operations. This week, CMS published Transmittal 574 that focused on four recent OIG reports:

  • Part B Chemotherapy Administration Payment and Policy;
  • Prevalence and Qualifications of Nonphysicians Who Perform Medicare Physician Services;
  • Inappropriate Medicare Payments for Chiropractic Services; and,
  • Part B Billing for Ultrasound.

In these reports, the OIG presented their findings and made recommendations for CMS to reduce the Medicare program’s vulnerability with regards to questionable claims. This transmittal directs all contractors – Carriers, Fiscal Intermediaries (FI), and Medicare Administrative Contractors (MAC) – to review the information contained in the OIG reports and begin to analyze claims data for these areas. If the contractor’s findings indicate potential problems with their providers and suppliers, they have been directed to take the appropriate action, which may include automated prepayment edits and/or pre- and post-payment reviews.

Hospitals should review this transmittal and the related OIG reports to identify any issues that may need to be addressed as soon as possible. Staying abreast of the OIG audit reports is necessary in today’s regulatory environment. These reports can help guide a facility’s compliance activities, help identify processes that may need correction and prevent recoupments in the future.

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Debbie Mackaman About the Author:

Debbie is an instructor for HCPro’s Medicare Boot Camp®—Hospital Version. She has over 18 years of experience in the healthcare industry, including both inpatient and outpatient Prospective Payment Systems (IPPS, OPPS) and Critical Access Hospital (CAH) coding and reimbursement issues. She most recently held the position of the Compliance Officer and Director of Health Information Services for a healthcare system.

She consults with hospitals, physicians and other healthcare providers on a wide range of coding and billing issues. She assists in the development of compliance programs, with a focus on high risk areas including RAC topics, documentation improvement, coding and billing audits, and chargemaster maintenance.

She is an active participant with state and national organizations and task forces on coding and payment policies, privacy and continuing education. She is accredited as a Registered Health Information Administrator (RHIA) and a Certified Healthcare Compliance Officer (CHCO). She is a member of the American Health Information Management Association (AHIMA) and is the past president of the Montana Health Information Management Association (MHIMA).

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