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Renew your NAMAS membership so you won’t lose your member benefits! Weekly Auditing Tips

Renew your NAMAS membership so you won’t lose your member benefits! Weekly Auditing Tips Quarterly Newsletters 6 free webinars each year (2 CPMA CEUs each webinar) Refer a friend to a CPMA Training class and receive your next year’s NAMAS membership free!

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Renew your NAMAS membership so you won’t lose your member benefits! Weekly Auditing Tips

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  1. Renew your NAMAS membership so you won’t lose your member benefits! • Weekly Auditing Tips • Quarterly Newsletters • 6 free webinars each year (2 CPMA CEUs each webinar) • Refer a friend to a CPMA Training class and receive your • next year’s NAMAS membership free! • Email blast alerts – what is happening of special interest • Discounted AMA Coding Manuals

  2. Welcome to the NAMAS Webinar: 2012 OIG Work Plan Speaker for Today’s Session: Shannon DeConda, CPC-I, CEMC, CMSCS, CPMA Founder of NAMAS Partner at DoctorsManagement

  3. Today’s Webinar • Basics of the OIG Work Plan • Specific targeted elements of the Work Plan • How to apply this knowledge to the daily principles of auditing • Q&A • WebEx chat box to the right

  4. The basic provisions and information regarding the OIG Work Plan. Basics of the OIG Work Plan

  5. Basics of the Work Plan • Released annually • The Office of Inspector General's (OlG) Work Plan sets forth various projects to be addressed during the fiscal year by the Office of Audit Services (OAS), Office of Evaluation and Inspections, Office of Investigations, and Office of Counsel to the Inspector General

  6. Basics of the Work Plan • Get Email Updates: Stay up to date on the latest OIG news and opinions • http://oig.hhs.gov/reports-and-publications/workplan/index.asp#emailAlerts • Services on the OIG Work Plan • Medicare A&B • Medicare C&D • Medicaid • ALL services billed to HHS

  7. Basics of the Work Plan • Referencing each section of the work plan: • Medicare Part A • Medicare Part B

  8. Review of OIG targets that relate specifically to CMS program integrity CMS Specifics

  9. CMS Specifics • Physician compliance with assignment rules • Patient rights and responsibilities • High reimbursements • POS Errors

  10. CMS Specifics • Incident-to Services • Opting Out of Medicare

  11. Addressing specific topics on the 2012 OIG Work Plan Let’s get specific

  12. Relevant to physician practices whether they provide the service or order the services Durable medical equipment (DME)

  13. Specifics of the OIG Work Plan • Medicare Enrollment and Monitoring for Suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies • Review of Medicare contractors’ processes for enrolling and monitoring suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). • Enrollment-screening mechanisms • Applicants omitted ownership information • Medicare contractors must conduct prescreening, verification, validation, and final processing of Medicare provider enrollment applications. • Post-enrollment monitoring activities

  14. Specifics of the OIG Work Plan • Why is DME targeted year after year? • One of the areas with the most significant fraudulent claims • CMS cracks down through enrollment • OIG MOST WANTED listing

  15. Andrei VulpeDOB: 05-13-1982 Height: 6'0"Weight: 160 lbs.WANTED Gautam GuptaDOB: 08-08-1954Height: 5'5"Weight: 160 lbs.WANTED Enrique GonzalezDOB: 08-24-1945Height: 5'6"Weight: UNK NEW DME Rodolfo BouzaDOB: 09-17-1965Height: 5'6"Weight: 159 lbs. WANTED ValentinMunteanuDOB: 03-21-1981 Height: 6'2"Weight: 190 lbs. WANTED Tom Henderson AlabrabaDOB: 02-14-1971 Height: 5'8"Weight: 150 lbs.WANTED DME DME DME Iyaye IshmaelDOB: UNKHeight: UNKWeight: UNKWANTED Robert Allen LopezDOB: 04-07-1966Height: 5'7"Weight: 170 lbs.WANTED Tariq UsmanDOB: 01-12-1965Height: 5'8"Weight: 165 lbs.WANTED DME AnupalGayenDOB: 01-27-1966Height: 5'4"Weight: 121 lbs.WANTED Jose Garcia-SuarezDOB: 10-01-1963 Height: 5'11"Weight: 150 lbs.WANTED DME

  16. Specifics of the OIG Work Plan • Other areas of DME that are on the Work Plan: • Qualifications of Orthotists and Prosthetists • Medicare Supplier Acquisition Costs for Back Orthoses • Power mobility devices • Hospital beds • Oxygen concentrators • Enteral/parenteral nutrition • Other DME • Diabetes supplies

  17. Specifics of the OIG Work Plan • DME audits will additionally review items that are automatically shipped • Continuous positive airway pressure system and respiratory-assist device supplies • Select a sample of claims for frequently replaced supplies • The order or Certificate of Medical Necessity must specify the frequency

  18. Various items on the OIG Work Plan Hodge podge of issues

  19. Specifics of the OIG Work Plan • Chiropractic services • Physician-owned distributors (POD) • Provide spinal implants purchased by hospitals • Review for high use of spinal implants • Claims payments are gaining momentum

  20. Specifics of the OIG Work Plan • Ambulatory Surgery Centers (ASC) • Review of payment system • Health and safety concerns • Hospital based • ASC services • Rise in reimbursable claims

  21. Specifics of the OIG Work Plan • Imaging services • Review the expenses incurred and whether the rates reflect industry standards • LCSW Services • Inpatient • SNF • Community Mental Health Centers • PHP billing • PHP as outpatient departments

  22. Specifics of the OIG Work Plan • Physical Therapy Services • Independent services • Sleep Testing (again????) • Clinic • Appropriateness of test • Diagnostic Radiology • High-cost diagnostic radiology tests • Verification of test ordered by primary and specialty providers

  23. Specifics of the OIG Work Plan • Lab Services • Glycated hemoglobin A1C • Frequency 3 months on a controlled diabetic patient • Trends in lab volume • Compare programs to each other

  24. Specifics of the OIG Work Plan • CORF Review • High-utilization • Rental arrangements • ESRD Patients • Qualified or not • Quality of Dialysis Centers • Bundling rules for dialysis services

  25. Specifics of the OIG Work Plan • G Modifier Services • Expect Denial • GA, GZ, GX, GY • Review of ordered services • Provider excluded from CMS? • Error-prone providers

  26. Thank you for your time, and we hope you found useful information within this webinar. Questions

  27. Join us at the next NAMAS Roundtable Session: • May 10, 2012 - Chemotherapy • May 24, 2012 - Teaching Physicians • June 14, 2012 - E&M • July 19, 2012 - Pediatrics • August 9, 2012 - Physical Therapy • August 30, 2012 - Ophthalmology • September 13, 2012 - Internal Medicine/Family Practice • September 27, 2012 - OB/GYN • October 11, 2012 - E&M • October 25, 2012 - Inpatient • November 1, 2012 - OIG • December 1, 2011 - Teaching Physicians & Incident-To • December 8, 2011 - OIG Target List • December 13, 2011 - Orthopedics • January 5, 2012 - Psychology • January 19, 2012 - Cardiology • February 2, 2012 - Pain Medicine • February 16, 2012 - Incident-To • March 1, 2012 - Dermatology • March 22, 2012 - Medical Necessity • April 12, 2012 - Nurse Visits • April 19, 2012 - Orthopedics

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