OIG Work Plan 2017 – What’s New for Hospitals?

OIG-Work-Plan-2017-Hospitals

The OIG Work Plan 2017 describes audits and evaluations that are underway or planned and certain legal and investigative initiatives that are continuing. This overview of the 2017 OIG Work Plan also notes items that have been completed, revised and removed and includes new items that have been started or planned since April 2016. Totaling over 100 pages this year, you can download the OIG 2017 Work Plan here on our website.

OIG Work Plan 2017 – What’s New for Hospitals?

The following information describes the changes (from the time period April 2016 through September 2016) in the CMS: Medicare Parts A and B section and the impact on hospitals.

  • Hyperbaric Oxygen Therapy Services – Provider Reimbursement in Compliance with Federal Regulations. Prior OIG reviews expressed concern that: 1) beneficiaries received treatments for noncovered conditions, 2) medical documentation did not adequately support HBO treatments, and 3) beneficiaries received more treatments than were considered medically necessary. The OIG will attempt to determine whether Medicare payments related to HBO outpatient claims were reimbursed in accordance with Federal requirements
  • Incorrect Medical Assistance Days Claimed by Hospitals. In Medicare, disproportionate share hospital payments to providers are based on Medicaid patient days that the hospitals furnish. The OIG will evaluate the performance of Medicare administrative contractors who settle Medicare cost reports, and calculate Medicaid patient days.
  • Inpatient Psychiatric Facility Outlier Payments. From FY 2014 to FY 2015, the number of claims with outlier payments increased 28% resulting in an increase in Medicare payments of 19%, from $450.2 million to $534.6 million. It will be determined whether inpatient Psychiatric Facilities complied with Medicare documentation, coverage, and coding requirements for stays that resulted in outlier payments.
  • Case Review of Inpatient Rehabilitation Hospital Patients – Not Suited for Intensive Therapy. The purpose of this study is to assess a sample of rehab hospital admissions to determine whether the patients participated in and benefited from intensive therapy. In addition, reasons will be identified why patients were not able to participate and benefit from the therapy.

OIG Work Plan 2017 – What Else Applies To Hospitals?

You need to know and check it out!  The OIG Work Plan 2017 continues the dynamic process and adjustments are made throughout the year to meet changing priorities.  The work plan also anticipates and responds to emerging issues with the resources available.  Hospitals need to review multiple areas, depending on the services they provide.

What are all the categories that apply to your hospital?

  • Medicare Parts A and B
  • Hospitals
  • Nursing Homes
  • Hospices
  • Home Health Services
  • Medical Equipment & Supplies
  • Other Providers & Suppliers
  • Electronic Health Records

When was the last time, or have you ever looked at the mission of the OIG?  “Our organization protects the integrity of HHS programs and operations and the well-being of beneficiaries by detecting and preventing fraud, waste, and abuse; identifying opportunities to improve program economy, efficiency and effectiveness; and holding accountable those who do not meet program requirements or who violate Federal health care laws”.

The Fox Group, LLC strives to keep our clients informed about the periodic changes in the Office of Inspector General’s work plan.  All health care organizations should review the OIG Work Plan 2017.  You should evaluate how audits conducted by the OIG can point you to internal audits you may do as part of your Corporate Compliance Program.

The OIG Work Plan 2017 is designed to be, and can be, a helpful tool – use it!

When you need proven expertise and performance

Alida L. Durej, MBA

Ms. Alida Durej has specific expertise preparing business cases and ROIs for expansion of clinical services, and partner effectively with client management, physicians, clinical teams and other key stakeholders to achieve their business and clinical goals.

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