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The Office of Inspector General (OIG) has recently released their 2003 work plan listing areas for investigation of physicians. Listed below are some of the target areas with guidelines to follow:

Consultations: When billing a consultation, you must have a Request (written or verbal) from another physician; the service is Rendered to the patient; and a Report must be sent back to the referring physician.

Coding of Medicare Physician Services: Review Medicare's National Correct Coding Initiative (CCI) when billing procedures to be certain that unbundled claims are not being sent and processed.

Coding of Evaluation and Management Services: Documentation must always support the Evaluation and Management code that is being billed. It is also important to review the utilization of codes billed for your practice against other practices of your specialty.

Bone Density Screenings: Documentation of medical necessity must be indicated for bone density screenings.

Billing for Chiropractic Care: The OIG will be reviewing improper payments made for chiropractic maintenance treatments which are a non-covered service by Medicare.

Services and Supplies Incident to Physicians' Services: Direct supervision must be followed (a physician must be present in the office suite) in order to bill "Incident-to" and be reimbursed 100% of the Medicare physician fee schedule.

The additional target areas of the OIG Work Plan can be reviewed on their web site, www.oig/hhs.gov

Maureen A. Doherty, CPC, CPC-H, is a Consultant with Amper's Healthcare Services Group. Maureen has more than 20 years of experience providing coding, documentation and revenue cycle services. Contact Maureen at 732-287-1000, ext. 301