2016 OIG work plan
Jeff Arnette
Description
Collection
Title:
2016 OIG work plan
Creator:
Jeff Arnette
Date:
11/5/2015
Text:
Dear list members here is the OIG work plan for 2016 I have pulled out the items affecting us.
Full link for u insomniac's
Jeff Arnette CPO/BOCPO
<URL Redacted>
NEW Orthotic braces–reasonableness of Medicare payments compared to amounts paid by other payers
We will determine the reasonableness of Medicare fee schedule amounts for orthotic braces. We will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payers, such as private insurance companies, to identify potentially wasteful spending. We will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare payers. (OAS; W-00-15-35756; expected issue date: FY 2016).
NEW Orthotic braces–supplier compliance with payment requirements
We will review Medicare Part B payments for orthotic braces to determine whether durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers’ claims were medically necessary and were supported in accordance with Medicare requirements. Prior OIG work indicated that some DMEPOS suppliers were billing for services that were medically unnecessary (e.g. beneficiaries receiving multiple braces and referring physician did not see the beneficiary) or were not documented in accordance with Medicare requirements. Medicare requires that such items be reasonable and necessary. (Social Security Act § 1862(a)(1)(A).) Further, LCDs issued by the four
NEW Physicians–referring/ordering Medicare services and supplies
We will review select Medicare services, supplies and durable medical equipment (DME) referred/ordered by physicians and non-physician practitioners to determine whether the payments were made in accordance with Medicare requirements. Pursuant to ACA Sec. 6405, CMS requires that physicians and non-physician practitioners who order certain services, supplies and/or DME are required to be Medicare-enrolled physicians or nonphysician practitioners and legally eligible to refer/order services, supplies and DME. If the referring/ordering physician or non-physician practitioner is not eligible to order or refer, then Medicare claims should not be paid.
(OAS; W-00-15-35748; expected issue date: FY 2016, AC
Sent from my iPhone
Sent from my iPhone
Full link for u insomniac's
Jeff Arnette CPO/BOCPO
<URL Redacted>
NEW Orthotic braces–reasonableness of Medicare payments compared to amounts paid by other payers
We will determine the reasonableness of Medicare fee schedule amounts for orthotic braces. We will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payers, such as private insurance companies, to identify potentially wasteful spending. We will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare payers. (OAS; W-00-15-35756; expected issue date: FY 2016).
NEW Orthotic braces–supplier compliance with payment requirements
We will review Medicare Part B payments for orthotic braces to determine whether durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers’ claims were medically necessary and were supported in accordance with Medicare requirements. Prior OIG work indicated that some DMEPOS suppliers were billing for services that were medically unnecessary (e.g. beneficiaries receiving multiple braces and referring physician did not see the beneficiary) or were not documented in accordance with Medicare requirements. Medicare requires that such items be reasonable and necessary. (Social Security Act § 1862(a)(1)(A).) Further, LCDs issued by the four
NEW Physicians–referring/ordering Medicare services and supplies
We will review select Medicare services, supplies and durable medical equipment (DME) referred/ordered by physicians and non-physician practitioners to determine whether the payments were made in accordance with Medicare requirements. Pursuant to ACA Sec. 6405, CMS requires that physicians and non-physician practitioners who order certain services, supplies and/or DME are required to be Medicare-enrolled physicians or nonphysician practitioners and legally eligible to refer/order services, supplies and DME. If the referring/ordering physician or non-physician practitioner is not eligible to order or refer, then Medicare claims should not be paid.
(OAS; W-00-15-35748; expected issue date: FY 2016, AC
Sent from my iPhone
Sent from my iPhone
Citation
Jeff Arnette, “2016 OIG work plan,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/237805.
