Significant Points for Physicians and Hospitals from the FY 2017 OIG Work Plan

Medicare Parts A & B

Hospitals

New:

• Hyperbaric Oxygen Therapy Services – Provider Reimbursement in Compliance with Federal Regulations
• Incorrect Medical Assistance Days Claimed by Hospitals
• Inpatient Psychiatric Facility Outlier Payments
• Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy

Revised:

• Intensity-Modulated Radiation Therapy

Ongoing:

• Outpatient Outlier Payments for Short-Stay Claims
• Comparison of Provider-Based and Freestanding Clinics
• Reconciliations of Outlier Payments
• Hospitals' Use of Outpatient and Inpatient Stays Under Medicare's Two-Midnight Rule
• Medicare Costs Associated with Defective Medical Devices
• Payment Credits for Replaced Medical Devices That Were Implanted
• Medicare Payments for Overlapping Part A Inpatient Claims and Part B Outpatient Claims
• Selected Inpatient and Outpatient Billing Requirements
• Duplicate Graduate Medical Education Payments
• Indirect Medical Education Payments
• Outpatient Dental Claims
• Nationwide Review of Cardiac Catheterizations and Endomyocardial Biopsies
• Payments for Patients Diagnosed with Kwashiorkor
• Review of Hospital Wage Data Used to Calculate Medicare Payments
• CMS Validation of Hospital-Submitted Quality Reporting Data
• Long-Term-Care Hospitals – Adverse Events in Postacute Care for Medicare Beneficiaries
• Hospital Preparedness and Response to Emerging Infectious Diseases

Physicians

New:

• Medicare Payments for Transitional Care Management
• Medicare Payments for Chronic Care Management
• Data Brief on Financial Interests Reported Under the Open Payments Program

Ongoing:

• Review of Financial Interests Reported Under the Open Payments Program
• Payments for Medicare Services, Supplies, and DMEPOS Referred or Ordered by Physicians – Compliance
• Anesthesia Services – Noncovered Services
• Anesthesia Services – Payments for Personally Performed Services
• Physician Home Visits – Reasonableness of Services
• Prolonged Services – Reasonableness of Services

Other Part A And Part B Program Management Isues

New:

• Medicare Payments for Service Dates After Individuals' Dates of Death
• Management Review: CMS's Implementation of the Quality Payment Program

Ongoing:

• Accountable Care Organizations: Beneficiary Assignment and Shared Savings Payments
• Accountable Care Organizations: Savings, Quality, and Promising Practices
• Use of Electronic Health Records to Support Care Coordination through ACOs
• Medicare Payments for Incarcerated Beneficiaries – Mandatory Review

Medicaid

New:

• Accountable Care in Medicaid

Ongoing:

• Physician-Administered Drugs for Dual Eligible Enrollees
• Medicaid Payments for Multiuse Vials of Herceptin
• Health-Care-Acquired Conditions – Prohibition on Federal Reimbursements

Electronic Health Records

• Medicare Incentive Payments for Adopting Electronic Health Records
• Security of Certified Electronic Health Record Technology Under Meaningful Use