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The 2007 OIG Work Plan and Ophthalmology

Every fall, the Office of Inspector General publishes a work plan for the coming year. It contains project areas believed to be “vulnerabilities” of the Department of Health and Human Services programs. The 2007 OIG’s work plan contains items specific to ophthalmology as well as other areas pertinent to ophthalmic practice. They include:

  • Eye Surgeries — A review to determine if payments for ophthalmology services related to cataract surgery and laser surgery were billed appropriately.
  • BoTox Treatments — Were payments appropriate for medically necessary treatments with BoTox?
  • E/M Services During Global Surgery Periods — Were appropriate payments made to physicians for services provided in the postoperative period?
  • “Incident to” Services — Plans to evaluate the appropriateness of services provided incident-to physician services. Do they meet documentation requirements, are they medically necessary, and is the quality of care appropriate?
  • DMERC Claims — Does the documentation exist to support claims with medically necessary modifiers?
  • Place of Service Errors — Does the place of service on the claim form match the place of service where services were actually performed?
  • Billing Service Companies — Examine the relationship between physicians and their billing companies. Does the relationship influence billing practices?

A copy of the complete work plan can be downloaded at: http://oig.hhs.gov/publications/docs/workplan/2007/Work%20Plan%202007.pdf

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