OIG Work Plan for Fiscal Year 2011

A quick review of the Office of Inspector General's work plan indicates 2011 reviews will continue to focus on ensuring providers can justify the appropriateness of what they are doing, either from a clincial perspective or a documentation perspective.

 

Evaluation & Management (E&M) claims will be evaluated to ensure:

•  Documentation supports the level of service reported - specifically that there is not identical documenation used to record the patient encounter for each & every patient. 
• Coding patterns, by provider, accurately reflect the service provided.  Specifically, that billing for E&M services reflect the individual type, setting and complexity of services provided to each patient.    

For services performed in hospital outpatient departments or ambulatory surgical centers (ASC), the OIG will audit to determine whether physicains properly coded the place of service on claims.  To review the current list of location codes used for billing go to: https://www.cms.gov/MedHCPCSGenInfo/Downloads/Place_of_Service.pdf