OIG Work Plan 2016: Top Things to Watch Out For

The Department of Health and Human Services Office of Inspector General (OIG) released a mid-year update to its 2015 Work Plan that covers the projects it will focus on during fiscal year 2014 and beyond. In 2016, the agency has added many new items on their agenda, including a provision related to OIG’s anticipated oversight of the Open Payments program, and also a provision stating that OIG plans to analyse CMS payments to the top 25 clinical diagnostic laboratories.

Here’s a peek at the items to watch for in OIG Mid-Year Update:

Clinical laboratory payments:

In 2016, the OIG plans to conduct an annual analysis of Medicare clinical diagnostic laboratory tests to examine expenditures and the new payment system.

Using EHR to support care coordination through ACO:

In 2016, the OIG will review the extent that providers participating in ACOs in the Medicare Shared Savings Program use electronic health records to exchange health information to achieve their care coordination goals.

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) requirements:

The OIG will review the compliance of the IRF PPS in 2016, which covers the documentation required in support of the claims paid by Medicare.

Intensity-modulated radiation therapy (IMRT) Services:

In past OIG review have identified hospitals that have incorrectly billed for IMRT services. Hospitals need to be aware that the OIG intends to review Medicare outpatient payments for IMRT beginning in 2016.

Effects of the Competitive Bidding Program on Medicare Beneficiaries Access to durable medical equipment:

The OIG have plans of determining the effects of the competitive bidding program on Medicare beneficiaries’ access to certain types of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—in 2016.

View the Work Plan here.

Leave a Reply

Your email address will not be published. Required fields are marked *