June 30, 2015

OIG Work Plan Mid-Year Update

The Office of Inspector General (OIG) Work Plan Mid-year Update forecasts areas for which the OIG anticipates planning and/or beginning work in the upcoming fiscal year and beyond. Typically, these broader areas of focus are based on the results of OIG’s risk assessments and have been identified as significant management and performance challenges facing HHS. Included in the OIG mid-year update are the following issues that pertain to radiology and radiation oncology.

The Office of Inspector General (OIG) will review:

  1. Medicare intensity-modulated radiation therapy outpatient payments for to determine whether the payments were made in accordance with Federal rules and regulations.
  2. Billing and payments for immunosuppressive drug claims to determine whether Part B payments for immunosuppressive drugs that were billed with a service code modifier “KX” met Medicare documentation requirements.
  3. Portable X-ray equipment supplier compliance with transportation and setup fee requirements and supported by documentation.
  4. Physicians place-of-service coding errors on Medicare Part B claims for services performed in ambulatory surgical centers and hospital outpatient departments to determine whether they properly coded the places of service.
  5. Part B payments for imaging services to determine whether they reflect the expenses incurred and whether the utilization rates reflect industry practices.
  6. Medicare payments for high-cost diagnostic radiology tests to determine whether the tests were medically necessary and to determine the extent to which use has increased for these tests.