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October 17, 2011

2012 OIG Work Plan - Looking at physicians

Physicians: Incident-To Services. OIG will review physician billing for incident-to services to determine whether payment for such services had a higher error rate than non-incident-to services. Assess CMS’s ability to monitor incident-to services.

Evaluation and Management Services: Use of Modifiers During the Global Surgery Period. OIG will review the appropriateness of the use of certain modifier codes during the global surgery period and whether Medicare payments for claims with such modifiers used during the global surgery period were in accordance with Medicare requirements.

Diagnostic Radiology: Excessive Payments. OIG will review of Medicare payments for high-cost diagnostic radiology tests to determine whether they were medically necessary and to determine the extent to which the same tests were ordered for a beneficiary by both a primary care physician and a specialist.

Providers and Suppliers: High Cumulative Part B Payments. OIG will review what controls are in place to identify high cumulative Medicare Part B payments to individual physicians and suppliers, or on behalf of an individual beneficiary, over a specified time period.

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