Medicare Compliance & Reimbursement

Although E/M services and place of service codes are used almost every day in Part B practices, those aren’t the only issues that the OIG will be spotlighting this year. These topics are also covered in the 2014 Work Plan:

• Chiropractic Services: The OIG will be investigating vulnerabilities in chiropractic billing trends, as well as researching whether chiropractors collected payments for services that aren’t covered, including maintenance therapy.
• Big-Ticket Radiology Services: Medicare doesn’t pay for diagnostic radiology services that aren’t reasonable and necessary, so the OIG plans to investigate whether payments for high-cost diagnostic radiologist tests were billed appropriately.
• Electrodiagnostic Testing: The OIG intends “to identify questionable billing for electrodiagnostic testing and determine the extent to which Medicare utilization rates differ by provider specialty, diagnosis, and geographic area” for services such as electromyograms and nerve conduction testing.
• Lab Tests: The OIG has found that Medicare payments for lab services increased by 92 percent over a ten year period, so the agency plans to determine whether any questionable billing took place for these lab tests.
• Ophthalmology Billing: Not only does the OIG believe ophthalmologists are collecting inappropriately, they think it could be a regional issue. “We will also determine the geographic locations of providers exhibiting questionable billing for ophthalmological services,” the OIG writes in the Work Plan.
• Physical Therapy: Previous OIG work “found that claims for therapy services provided by independent physical therapists were not reasonable or medically necessary or were not properly documented,” the Work Plan states. Therefore, the OIG plans to investigate whether outpatient PTs’ services were reasonable and necessary.

To read the complete 2014 Office of Inspector General Work Plan, visit the OIG website at http://oig.hhs.gov/reports-and-publications/archives/workplan/2014/Work-Plan-2014.pdf.