A Physician Coder’s Guide to the 2010 OIG Work Plan
Posted on 13. Oct, 2009 by in Provider News
If your practice does lab panels, sleep studies, hospice visits and more, take heed.
The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year.
Why you should care: The 115-page document is like a map for what regulators will be looking at this year, and what potential problems they’ll be passing to MAC, RAC and private payer auditors. Don’t worry. Physician issues are clustered around page 15. However, if you code for other things in your health system besides physician services, you should have a look at the table of contents.
Here’s a summary of what the OIG wants to know about physician reimbursement:
Modifier GY: By law, Medicare excludes some medical treatments, such as many screening tests, and you might want to inform patients of this fact. Although you’re not required to issue a notification to patients for excluded procedures, doing so is a courtesy to the patient and may help the process of collecting from the patient. In these cases, modifier GY applies. Medicare denied over $820 million in modifier GY claims in fiscal year 2008, and the OIG wants to further research “patterns and trends for physicians’ and suppliers’ use of modifier GY,” the Work Plan notes.
Place-of-service errors continue to be a hot-button issue for the OIG. Reimbursement for certain procedures is higher when a physician performs them in the office than when she performs them in an ambulatory surgical center or hospital outpatient department.
POS errors sometimes occur because new billers assume that every setting the physician works in is an ‘office.’ And sometimes billing software errors cause them,...
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