Practicefirst would like to make you aware of recently added items to the Office of Inspector General (OIG’s) Work Plan.
Review of Inappropriate denial of services for Medicare Advantage claims.
The OIG is conducting medical record reviews to determine where claims for providers were denied preauthorization or payment for medical necessary services covered by Medicare. They will be determining the reasons for any inappropriate denials and the types of services involved.
Review of Medicare Part B claims for dialysis services provided to beneficiaries with End-Stage Renal Disease (ESRD) to determine whether such services complied with Medicare requirements.
In previous OIG work, it was identified that unallowable Medicare payments occurred for treatments not furnished or documented. This included:
Insufficient documentation to support medical necessity
Services not ordered by a physician or ordered by a physician that was not treating the patient
For Compliance questions, please contact Becky Amann at 716-389-3202 or firstname.lastname@example.org