Keep Your Finger on the OIG Pulse by Knowing Where to Find Audit Targets

Keep your finger on the OIG pulse

OIG audit targets can feel like moving targets with the website updated each month. Find out where you can go to keep tabs on the Office of Inspector General’s Work Plan items, and see an example of a recently added area to watch. (Tip: For more OIG information, you also can check out this free TCI SuperCoder webinar.)

Bookmark These OIG Pages to Stay on Top of What’s New

You can get started on the OIG Work Plan page for an overview about how OIG works. There are also links to recently added Work Plan items, active Work Plan items, and a Work Plan archive on that page. OIG used to release the Work Plan once or maybe twice a year but now aims to update the site monthly to better keep up with (and keep the public informed about) changing priorities.

Don’t miss this: At the bottom of the page, there’s a link to recently completed and published reports. That OIG What’s New page gives you a home base to learn about the consequences that occur when the OIG finds problems, read advisory opinions, review factsheets, and check more sources for insights into OIG workings.

Here’s a Podiatry Example to Get You Started

In February 2019, OIG added Medicare Part B Payments for Podiatry and Ancillary Services as a Work Plan item for CMS. According to the page for this issue, OIG has identified inappropriate payments by Medicare Part B for podiatry and ancillary services. And if OIG is telling Medicare there’s a problem, there’s a good chance Medicare auditors will be paying extra attention to this area to avoid paying out money when services are not covered.

The Work Plan item offers these hints:

  • Covered: “Medicare Part B covers podiatry services for medically necessary treatment of foot injuries, diseases, or other medical conditions affecting the foot, ankle, or lower leg.”
  • Routine NOT covered: Part B generally does not cover routine foot-care services. Examples include cutting or removing corns and calluses, or trimming, cutting, clipping, or debridement of toenails.
    • Exceptions: Part B may cover the listed services if the provider performs them under these circumstances:
      • as a necessary and integral part of otherwise covered services
      • for treating warts on the patient’s foot
      • in the presence of one or more systemic conditions
      • for treating infected toenails.
    • E/M: Medicare generally does not cover E/M services provided on the same date of service as another podiatry service, such as a covered nail debridement service.
      • Exception: Medicare Part B may cover an E/M service in addition to the podiatry service if they are significant, separately identifiable services.
    • Allowed: Podiatrists may order, refer, or prescribe medically necessary ancillary services. Examples include X-rays, laboratory tests, physical therapy, durable medical equipment (DME), or prescription drugs.

What About You?

Do you keep an eye on the OIG Work Plan and pay particular attention in your own work to areas being scrutinized by the OIG?

 

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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