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4 OIG Updates for Rev Cycle Leaders

Analysis  |  By Amanda Norris  
   June 02, 2023

The Office of Inspector General (OIG) is eyeing improper payments, over payments, and denied claims.

Regulatory burdens are top of mind for revenue cycle leaders as they work to increase reimbursement and improve their bottom lines. The OIG has been keeping its eye on improper payments, over payments, denied claims, and more, so staying abreast of the OIG’s work is essential in making sure your revenue cycle runs smoothly.

Check out some of the recent findings you may have missed:

OIG Audit Uncovers $580M in Improper Medicare Payments for Psych Services

More than half of the $1 billion in temporary pandemic-related psychotherapy services paid by Medicare in the first year of the public health emergency were incorrectly billed, federal auditors say.

The OIG examined the CMS’ mental health services records for both in-person and telehealth visits from March 2020 through February 2021 at the start of the public health emergency.

The audit covered approximately $1 billion in Part B payments for more than 13.5 million psychotherapy services during the period. The audit picked two random samples of psychotherapy services: one of 111 enrollee days for telehealth services, and the other of 105 enrollee days for in-person services.

Learn more about this audit here.

Medicare Paid Providers $128M in Duplicate Payments for VA Care

Medicare overpaid providers about $128 million over five years for medical care that the Veterans Administration (VA) had already paid for, federal watchdogs report.

The OIG determined that the "duplicate payments occurred because the Centers for Medicare & Medicaid Services did not implement controls to address duplicate payments for services provided to individuals with Medicare and VHA benefits."

Read the full story here.

OIG: Identifying Denied Claims in Medicare Advantage Needed to Combat Fraud

Requiring MA organizations (MAOs) to identify when payment claims are denied would improve oversight of fraud and abuse, according to the OIG.

The HHS watchdog conducted a study to examine whether the lack of an indicator to identify payment denials in MA encounter data makes it harder for proper oversight of MAOs.

Read about it here.

OIG IDs $216M in Possible Medicare Drug Testing Overpayments; CMS Rejects Claw Back

Federal watchdogs are recommending that the CMS claw back as much as $216 million for noncompliant definitive drug testing paid to at-risk Medicare providers.

The OIG audited $3 billion in Medicare Part B payments between 2016 and 2020 and found that CMS had paid $704 million over that period for definitive drug testing services made to more than 5,200 providers.

The audit found that 1,026 at-risk providers in the five-year period routinely billed for a definitive drug testing service with the highest reimbursement amount (procedure code G0483) more than 75% of the time, compared with 4,227 "other providers" who "did not routinely bill this service."

Review more details from the audit here.

Amanda Norris is the Director of Content for HealthLeaders.

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