Archive for December 8th, 2010

December 8, 2010

2011 OIG Work Plan focuses on payments

If you haven’t seen it yet, or you don’t know about it, the Office of the Inspector General is implementing its FY2011 Work Plan. The great thing about OIG is that the agency spells out exactly what  it will be focusing on in each care continuum.

Here’s a look at the HHA (Medicare Part B) focus:

Payments for HH Beneficiaries: The OIG will review Part B payments for services and medical supplies provided. The agency specifically mentions identifying payments to outside supplies to examine controls.

HHA Claims for Medicare HHRG: Coverage requirements (homebound, intermittent care, under care of MD, etc.) are a focus. OIG will also assess the accuracy of HHRGs submitted in 2008.

Oversight of OASIS: OIG will review CMS’s oversight of OASIS data. The focus is to review CMS’s process that should ensure that HHAs submit accurate, complete data.

HHPPS Controls: This includes reviews for billings at the appropriate service location. This focus will analyze HHA activities on items such as the number of claims submitted, number of visits provided, ownership information, and arrangements with other facilities.

HHA Profitability: This analysis items seeks to determine whether the payment methodology should be adjusted.

Medicare HHA Enrollment: This item really focuses on cross relationships with suppliers and ownership. OIG specifically mentions that previous work found that DME suppliers omitted or provided inaccurate information … and that these suppliers were often associated with HHAs through shared owners or managers.

See OIG’s focus across the health care spectrum.

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