Pediatric Coding Alert

Plus: Medicaid audits will determine whether special need school services were medically necessary.

The HHS Office of Inspector General (OIG) has some big plans next year for reviewing your claims, and they span the whole spectrum of issues, according to the OIG's 2013 Work Plan, released on Oct. 2. Get to know these hot buttons before you press them.

Background: The OIG releases a Work Plan every year to alert the medical community of the issues that it will be scrutinizing in the coming year. Although most of the topics are related to Medicare, the Work Plan also covers Medicaid issues, including the following potential big topics, among others:

Antipsychotic pediatric medications: The OIG will be investigating the extent to which children ages 18 and younger had Medicaid claims for atypical antipsychotic drugs during the selected timeframe. The OIG will review records to determine whether the antipsychotic drug claims were for off-label uses or indications not listed for these medications.

Special need school services: The OIG will also review Medicaid payments for school-based services to determine whether those services are reasonable. "Direct medical services may include physical therapy, occupational therapy, speech therapy, and nursing, personal care, psychological, counseling, and social work services," the OIG report notes. The OIG will attempt to determine which of these services were paid appropriately.

RAC appropriateness: The OIG will also be investigating how the recovery audit contractors (RACs) who review state Medicaid programs have been performing. Some pediatric practices have heard from RACs, who have reviewed their Medicaid claims, while most pediatric practices have not yet been under the RACs' scrutiny.

To review the complete list, read the Work Plan at https://oig.hhs.gov/reports-and-publications/archives/workplan/2013/Work-Plan-2013.pdf.