More Audit Triggers in 2007

In 2007 the OIG is planning on zeroing in on incident to billing claims. In the update issued in October 2006, the HHS Office of Inspector General plans to issue a report on whether you are following all the requirements for incident -to billing, including direct physician supervision. The OIG wants to know whether these services met the Medicare standards for medical necessity, documentation and quality of care, according to the OIG’s 2007 Work Plan. Other topics include:

Other things that will be closely studied in the report include global periods and how they are determined in the medical billing. The agency will also be in the lookout for assignment violations where the physician has billed the patient more than Medicare co-pays for a service. They will also be ascertaining if the physician is notifying patients of their right to not be overcharged.

Imaging services will also come under close scrutiny. Medicare paid out $7 billion in 2005 and will be looking at all imaging services for medical necessity and proper medical billing.

The popularity of eye surgery is also under the microscope of scrutiny. If the OIG suspects that you are billing for cataract and lasik eye surgeries in ways that do not meet Medicare requirements, you could find yourself under audit and quickly.

View all Articles by: Kathryn Etienne, CCS-P