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The 2009 OIG Work Plan

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 2009 OIG work plan contains items specific to ophthalmology as well as other areas pertinent to ophthalmic practice. They include:

  • Place of Service Errors – Does the place of service on the claim form match the place of service where services were actually performed?
  • E/M Services During Global Surgery Periods – How frequently are claims paid for services provided in the postoperative period?
  • Practice Expenses Incurred by Selected Specialties – A review of actual expenses for some specialties (not named in the plan).
  • Physicians’ Services Performed by Nonphysicians – A review of “incident to” billing.
  • Patterns of High Utilization of Ultrasound Services – Review of geographic areas with high utilization of ultrasounds.
  • Payments for Unlisted Procedure Codes – A review of payments for unlisted procedure codes and provider use of these codes.
  • Medicare Billings with Modifier GY – Examine the use of modifier GY and its appropriateness.
  • Ambulatory Surgery Center Payment System – Review of method for setting ASC rates under the revised ASC payment system.

Additional topics exist in the plan. The above topics were called out because of their applicability to vision care providers. We encourage you to review the full report at:

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