FRAUD AND ABUSE
The latest report from the government and posted in Medical Economics describe where the government will be focusing their attention.
The current thinking is based on the results of the latest annual review done by the HHS Office of Inspector General. They have given their staff of 1,500 their marching orders to further detect fraud and abuse, in the following areas:
Coding. The government's fraud busters are going to look at claims for services performed in ambulatory surgical centers (ASCs) and hospital outpatient departments, since Medicare pays different rates depending on where the work is done. Higher amounts are paid for services provided in "non-facility" settings such as a doctor's office, so HHS will be looking to see that physicians are properly coding the place of service.
Medical necessity. In particular, HHS will focus on psychiatric services, to determine if they're reasonable and medically indicated. The same goes for payments for polysomnography—a type of diagnostic test for patients who have a suspected sleep disorder—and claims paid under Part B for services to nursing-home beneficiaries who live a significant distance from their physicians.
E&M services. Also under the microscope in 2008 will be the number of evaluation and management services provided as part of the global surgery fee. The permissible number of E&M services may have shifted since the global surgery fee concept came about in 1992, so HHS wants to reassess things.
"Incident to" services. This area has been in the Feds' crosshairs before. Again, the government wants to review physician claims for the "incident to" services of allied health professionals—NPs, PAs, and others—to make sure they're appropriate and of sufficient quality.
This is just more to look forward to for 2008!
The current thinking is based on the results of the latest annual review done by the HHS Office of Inspector General. They have given their staff of 1,500 their marching orders to further detect fraud and abuse, in the following areas:
Coding. The government's fraud busters are going to look at claims for services performed in ambulatory surgical centers (ASCs) and hospital outpatient departments, since Medicare pays different rates depending on where the work is done. Higher amounts are paid for services provided in "non-facility" settings such as a doctor's office, so HHS will be looking to see that physicians are properly coding the place of service.
Medical necessity. In particular, HHS will focus on psychiatric services, to determine if they're reasonable and medically indicated. The same goes for payments for polysomnography—a type of diagnostic test for patients who have a suspected sleep disorder—and claims paid under Part B for services to nursing-home beneficiaries who live a significant distance from their physicians.
E&M services. Also under the microscope in 2008 will be the number of evaluation and management services provided as part of the global surgery fee. The permissible number of E&M services may have shifted since the global surgery fee concept came about in 1992, so HHS wants to reassess things.
"Incident to" services. This area has been in the Feds' crosshairs before. Again, the government wants to review physician claims for the "incident to" services of allied health professionals—NPs, PAs, and others—to make sure they're appropriate and of sufficient quality.
This is just more to look forward to for 2008!
Labels: healthcare, regulation
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