On Friday, the Office of Inspector General (OIG) published a mid-year update to its 2015 Work Plan.  This update summarizes new, ongoing, and upcoming reviews/activities that the OIG is currently working on or plans to pursue.

Below is a summary of new activities for hospitals, physicians, and durable medical equipment (DME) suppliers.

HOSPITALS

• Intensity-Modulated Radiation Therapy (IMRT) – The OIG will review Medicare outpatient payments for IMRT to ensure services were billed correctly.

• Hospital Preparedness and Response to High-Risk Infectious Diseases – Describe hospitals’ efforts to prepare for possible public health emergencies resulting from infectious disease.  Also review use of HHS resources and identify lessons learned through recent issues with infectious disease, like Ebola.

PHYSICIANS

• Annual Analysis of Medicare Clinical Laboratory Payments – The OIG will analyze Medicare payments for clinical diagnostic laboratory tests, including the top 25 tests by expenditures in 2014.  Previous analysis shows Medicare pays more for certain tests than other insurers.  A new payment system for laboratory tests is slated for 2017.

• Inpatient rehabilitation Facility Payment System Requirements – Review compliance with IRF PPS including documentation to support Medicare paid claims.

DME

• Access to DME in Competitive Bidding Areas – Evaluate how the competitive bidding program has effected access for Medicare beneficiaries.

We recommend Medicare providers review the Work Plan Update for FY 2015 in its entirety.  We also recommend providers conduct proactive audits of the applicable areas identified in the update.

HC Healthcare Consulting staff includes certified coders, physicians, consultants certified in healthcare compliance and statisticians that are available to provide expert assistance with your Medicare and Medicaid compliance programs.

To read the complete FY 2015 Work Plan Update, please click on the following link:  http://oig.hhs.gov/reports-and-publications/archives/workplan/2015/WP-Update-2015.pdf

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.