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Updates to the OIG Work Plan

Updates to the OIG Work Plan April 21, 2020

There are several notable additions to the OIG Work Plan which include:

  • Medicare Part B Payments for Co-surgery Procedures – The focus will be on auditing claims where different physicians billed for the same CPT code with modifier 62 (co-surgery), for the same beneficiary, on the same date of service.  For co-surgeries reported with modifier “62”, each co-surgeon gets 62.5% of the global surgery fee schedule amount. The objective is to determine if payments for co-surgery procedures were properly made.
  • Post-Acute Care Transfer Policies – Under the Medicare policy, certain DRG payments (transfer DRGs) are reduced when a patient is transferred from inpatient status to specified types of post-acute care providers, including skilled nursing facilities, inpatient rehabilitation facilities and home health agencies.  The OIG will review hospital discharges that were paid a full DRG payment when the patient was transferred to a facility covered by the post-acute-care transfer policy.  
  • COVID-19 Hospital Response Study– The OIG will survey 400 hospitals nationwide to gain insight regarding hospitals’ needs and concerns in diagnosing and treating patients with COVID-19.  They will also be gathering information for other emergency preparedness and response issues, including needs for personal protective equipment for hospital staff.  The results will provide HHS with timely feedback on how they can support hospitals responding to COVID-19.

We recommend you review all active Work Plan items to identify known risk areas that may affect your organization.  Identified risk areas applicable to your organization should be incorporated into your auditing and monitoring efforts to evaluate your compliance with the regulations and guidelines.  HBE’s team of experts is available to assist you with risk assessments, routing auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.

The OIG Work Plan can be found at:

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