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Medicare Compliance & Reimbursement

Compliance:

OIG to Focus on Incident-to Claims, E/M Services, And More in 2012

Published on Sun Sep 18, 2011

New OIG Work Plan offers insight into where the agency will be focusing its reviews next year. The HHS Office of Inspector General (OIG) has some big plans next year for reviewing Part B claims, and they span the whole spectrum of issues, according to the OIG's 2012 Work Plan, released on Oct. 5. Get to know these hot buttons before you press them. 1. Incident-to services: The OIG intends to determine whether payment for incident-to services showed a higher error rate than non-incident-to services. "Incident-to services represent a program vulnerability in that they do not appear in claims data and can be identified only by reviewing the medical record," the Work Plan notes. "They may also be vulnerable to overutilization and expose Medicare beneficiaries to care that does not meet professional standards of quality." Best practice: Don't bill incident-to unless you're sure you've met the requirements. To qualify for [...]
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