Physician issues on list for inspector general's review of Medicare

Procedure code discrepancies, advance beneficiary notices, and evaluation and management codes are among items the office plans to review.

By Markian Hawryluk, AMNews staff. Oct. 22/29, 2001.

Washington -- Physician issues appear prominently on the list of investigations planned for fiscal year 2002 by the Dept. of Health and Human Services' Office of Inspector General. Several of those examinations could impact current efforts to solve Medicare problems.

For example, the OIG work plan includes a review of the procedure codes billed by both a hospital and physician for the same outpatient service. OIG said a previous review identified a 23% inconsistency rate between hospital outpatient department coding and physician procedure coding.

In the recently released hospital outpatient prospective payment system rule, however, the Centers for Medicare & Medicaid Services indicated that, at least for evaluation and management services, the codes do not adequately describe nonphysician resources.

"Therefore, we would not expect to see a high degree of correlation between the code reported by the physician and that reported by the facility," CMS said in the final rule.

Additionally, the OIG said it will look at the use of advance beneficiary notices and their financial impact on beneficiaries and physicians. Doctors have consistently criticized the language and the administrative burden of the form.

CMS designated the notices as one of the top priorities for its Practicing Physicians' Advisory Council to examine, and earlier this year proposed a one-page form that would eliminate the term "not medically necessary" that riled physicians and confused beneficiaries. The OIG work plan appears to include only a general review of the notices. It's unclear how the report might impact PPAC's efforts. [...]