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The OIG Work Plan

The OIG Work Plan. The 2013 OIG Work Plan. OIG Work Plan. OIG Work Plan. OIG investigative objectives for healthcare provider :. OIG Work Plan. OIG Work Plan. OIG Work Plan. Provider Based Policies. Outpatient PPS. Outpatient PPS (continued). Consider. . . Outpatient PPS .

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The OIG Work Plan

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  1. The OIG Work Plan The 2013 OIG Work Plan

  2. OIG Work Plan

  3. OIG Work Plan • OIG investigative objectives for healthcare provider :

  4. OIG Work Plan

  5. OIG Work Plan

  6. OIG Work Plan

  7. Provider Based Policies

  8. Outpatient PPS

  9. Outpatient PPS (continued) Consider. . .

  10. Outpatient PPS

  11. Outpatient PPS Consider. . .

  12. Outliers

  13. Outliers Consider. . .

  14. Never Events or Present on Admission

  15. Medical Devices- Warranty and Replacements

  16. Medical Devices- Warranty and Replacements

  17. Dental Services

  18. Physicians -Place of Service (POS) Errors

  19. Physicians - “Incident to” Services

  20. Evaluation and Management Services:Aberrant Billing Patterns

  21. E/M Services • EHR “Cloning” - Medicare contractors have noted an increased frequency of medical records with identical documentation across services. Issue • Copy and paste functionality • Consider limiting ability to pull previous information forward or at least limiting where the info may be placed • Medical necessity • Per Medicare IOM 100-04 Chapter 12 § 30.6.1: • “Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary or appropriate to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed. “ Consider

  22. Diagnostic radiology

  23. Personally Preformed Anesthesia Services

  24. Nerve conduction Testing

  25. Other OIG Concerns

  26. 2013 OIG Work Plan

  27. The Work Plan as a Tool

  28. Working with the OIG Work Plan

  29. Questions or Comments?

  30. Contact Today’s Speakers. . . Presented by Maggie Fortin, CPC, CPC-H, CHC Ext. 7547 Mfortin@bnncpa.com BAKER | NEWMAN| NOYES 280 Fore Street Portland, ME 04101 1-800-244-7444 www.bnncpa.com

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