OIG Work Plan – Critical Care E/M Update

Practicefirst has received notification of an update added to the OIG Work Plan, in August, regarding Critical Care E&M services.

The OIG states: Critical care is usually provided in a critical care area such as a coronary, respiratory, or intensive care unit or the emergency department. Payment may be made for critical care services provided in any location as long as the care provided meets the definition of critical care. Critical care is exclusively a time-based code. Medicare pays physicians based on the number of minutes they spend with critical care patients. The physician must spend this time evaluating, providing care and managing the patient’s care. They must be immediately available to the patient.

The OIG’s review, with an expected due date of 2019, will determine if Medicare payments for critical care were appropriate and paid in accordance with Medicare requirements.

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