OIG Work Plan for 2013

by User Not Found | Dec 01, 2012
The Office of the Inspector General (OIG) has released its work plan for 2013. Once again, on the list for scrutiny on the Part B side of the Medicare program, is medical necessity of high-cost diagnostic imaging tests.

The Office of the Inspector General (OIG) has released its work plan for 2013. Once again, on the list for scrutiny on the Part B side of the Medicare program, is medical necessity of high-cost diagnostic imaging tests. The OIG will be comparing referral rates for high-cost imaging studies of primary care physicians and specialists for the same treatment. They will also continue to look at imaging utilization rates and compare them to industry standards. Particular attention will be paid to the practice expense component for selected studies.

The error rate for “incident to” services performed by nonphysicians is a new item on the work plan. A 2009 OIG study found many issues in this area and Medicare will also be looking at its own ability to properly monitor this issue.

Place of Service errors continue to make the list again this year for services performed in Ambulatory Surgical Centers and hospital Outpatient departments. Services performed in a non-facility setting are paid at a higher rate than those in a facility setting.

Other issues that made the 2013 list are studies of modifier use during global surgical periods and erroneously paid claims with “G” modifiers.

Joe Calandra CMO, Midwest Imaging Professionals
Joe Calandra - CMO, Midwest Imaging Professionals
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