Outpatient Facility Coding Alert

Question: We have heard that the OIG work plan has listed outpatient reimbursement to be subjected to OIG scrutiny. What are the probable areas that we need to prepare ourselves in?

Maine Subscriber

Answer: The OIG work plan 2016, mid-year update does make mention of outpatient payments. Here is a precise list of areas to watch for:

1. Outpatient Outlier Payments for Short-Stay Claims: The OIG will target excessive outpatient patient outlier payments resulting from hospital outpatient services providing access to care in higher numbers. OIG plans to examine any unnecessarily inflated charges by the hospital that are not cost-based.

2. Intensity-Modulated Radiation Therapy: The OIG may scan to catch you on specific services that should ideally not be billed as a part of the IMRT plan.

3. Medicare Oversight of Provider Based Status: In case you are billing as hospital outpatient departments, and getting paid more for similar services (according to OIG), get ready as OIG will examine the provider-based status for hospital owned provider-based facilities.

4. Analysis of Salaries in Hospital Cost Reports: The OIG aims to evaluate the salary amounts attributed to overall operating costs and determine possible areas of cost savings. As of now, you may quote any amount of salary in the hospital cost reports.  

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