Office of Inspector General Releases FY 2017 Work Plan for Hospitals

PUBLISHED: Nov 15, 2016

The U.S. Department of Health and Human Services Office of Inspector General (OIG) issued its Work Plan for fiscal year (FY) 2017 summarizing new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. Today’s StayAlert! Notice reviews those aspects of the Work Plan specific to hospitals.

Below is a summary of some of the areas that OIG will focus on for hospitals in 2017. See the OIG’s Work Plan for a complete listing of focus areas.

  • NEW: Hyperbaric Oxygen Therapy Services—Provider Reimbursement in Compliance with Federal Regulations: In accordance with CMS Publication 100-03, National Coverage Determinations Manual, Ch. 20, § 20.29(A), a beneficiary must meet 1 of 15 covered conditions for providers to receive HBO reimbursement. OIG will determine whether Medicare payments related to HBO outpatient claims were reimbursed in accordance with Federal requirements.
  • NEW: Incorrect Medical Assistance Days Claimed by Hospitals: OIG will determine whether, with respect to Medicaid patient days, if Medicare administrative contractors properly settled Medicare cost reports for Medicare disproportionate share hospital payments in accordance with Federal requirements.
  • NEW: Inpatient Psychiatric Facility Outlier Payments: OIG will determine whether Inpatient Psychiatric Facilities nationwide complied with Medicare documentation, coverage, and coding requirements for stays that resulted in outlier payments.
  • NEW: Case Review of Inpatient Rehabilitation Hospital Patients Not Suited for Intensive Therapy: OIG will assess a sample of rehabilitation hospital admissions to determine whether the patients participated in and benefited from intensive therapy. For patients who were not suitable candidates, OIG will indentify reasons they were not able to particiapte and benefit from therapy.
  • REVISED: Intensity-Modulated Radiation Therapy: IMRT is provided in two treatment phases: planning and delivery. Certain services should not be billed when they are performed as part of developing an IMRT plan. Prior OIG reviews identified hospitals that incorrectly billed for IMRT services. OIG will review Medicare outpatient payments for IMRT to determine whether the payments were made in accordance with Federal requirements.

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