United States: The 2014 OIG Work Plan: Select Provisions Applicable To Physician Practices

Last Updated: February 27 2014
Article by Rose J. Willis

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recent issued its 2014 Work Plan outlining its intended review activities of HHS Programs for 2014. This article summarizes certain portions of the 2014 Work Plan that are of considerable importance to physician practices.

  • Security of Protected Health Information. The OIG will evaluate security programs, including security controls to prevent the loss of protected health information (PHI) stored on portable devices (e.g., laptops, jump drives, etc.). The OIG will also review whether security controls over networked medical devices (e.g., dialysis machines, radiology systems and medication dispensing systems) are sufficient to effectively protect electronically protected health information (ePHI). Physician practices should ensure that their HIPAA Security Policies and Procedures are in place, up to date, and are being adhered to by their workforce members.
  • Medicare/Medicaid Incentive Payments. The OIG has planned to review Medicare and Medicaid incentive payments made to eligible health care professionals and hospitals for adoption of Electronic Health Records ("EHR") and safeguards to prevent erroneous incentive payments.
  • Security of ePHI. The OIG will review various covered entities that receive incentive payments and their business associates, including EHR cloud service providers, to determine whether the security measures in place adequately protect the electronic information created or maintained by the certified EHR technology. The review will include audits of cloud service providers and other downstream service providers to assure compliance with the regulatory and contractual obligations.
  • Compliance with HIPAA. The OIG will review HHS's Office of Civil Rights ("OCR") oversight of covered entities' compliance with the HIPAA Privacy Rule and the HITECH Breach Notification Rule.
  • Payment for Medical Equipment. The OIG will begin a new study assessing the reasonableness of the Medicare fee schedule amounts for various medical equipment items, including commode chairs, folding walkers and transcutaneous electrical nerve stimulators. The OIG will also determine the reasonableness of Medicare reimbursement rates for Parenteral Nutrition compared to amounts paid by other payers.
  • Payments for Nebulizer Machines and Related Drugs. The OIG will begin reviewing Medicare Part B payments for nebulizer machines and related drugs to determine if Medicare requirements are being met.
  • Documentation of Evaluation and Management (E/M) Services. The OIG will continue to determine the extent to which selected payments for E/M services were inappropriate. Also, because Medicare contractors have noted an increased frequency of medical records with identical documentation across services, the OIG will continue reviewing multiple E/M services associated with the same providers and beneficiaries to determine whether the medical records have documentation vulnerabilities.
  • Coverage Criteria for Part B Drugs. The OIG will review the oversight actions that CMS and its claims processing contractors take to ensure payments for "on-label" and appropriate "off-label" uses for Part B drugs meet the appropriate coverage criteria. The OIG also plans to examine Medicare Administrative Contractors' policies and procedures for reviewing and processing Part B claims for compounded drugs.
  • Ambulatory Surgical Centers (ASC). The OIG will determine whether a payment disparity exists between the ASC and hospital outpatient department payment rates for similar surgical procedures provided in both settings. The OIG will also review physicians' coding of Medicare Part B for services performed in ASCs and hospital outpatient departments to determine whether the places of service are properly coded.
  • Laboratory Tests. The OIG will continue its focus on reviewing billing characteristics for Part B clinical laboratory tests to identify questionable billing practices.
  • Diagnostic Radiology. The OIG will continue its focus on reviewing Medicare payments for high-cost diagnostic radiology tests to determine medical necessity and a potential increase in utilization.
  • Imaging Services. The OIG will continue its focus on reviewing Medicare Part B payments for imaging services to determine whether they reflect the expenses incurred and whether utilization rates reflect industry practices. For selected imaging services, the OIG will focus on the practice expense components (e.g., office rent, wages and equipment), including the equipment utilization rate.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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Rose J. Willis
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