AHA Coding Clinic® for HCPCS - 2001 Quarter 4; FOR your INFORMATION
OIG to Look for consistency in hospital/physician coding
The Office of the Inspector General has released its FY 2002 Work Plan. As part of the office’s review, they plan to review the procedure coding of outpatient services billed by a hospital and a physician for the same service. The OIG reports that in previous review, they identified a 23% nationwide rate of inconsistency between the hospital outpatient department procedure coding and physician procedure coding for the same outpatient service. The review is expected to determine whether these coding differences continue and how they affect the Medicare Program. The OIG’s FY 2002 work plan is available...
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Article Overview
This short article covers an Office of Inspector General work plan item for FY 2002 involving a review of procedure coding consistency between hospital outpatient departments and physicians for the same outpatient service. It is relevant to compliance, billing, and coding professionals who monitor outpatient coding alignment and Medicare program oversight. The piece provides a brief overview of the review focus, the reported inconsistency rate from prior review, and the general program area being examined.
Why This Topic Matters
It matters because coding consistency between facility and physician claims can affect compliance reviews, reimbursement integrity, and Medicare oversight efforts.
What You Will Learn
- The general focus of the OIG work plan item
- Why hospital and physician outpatient coding consistency is being reviewed
- How the review relates to Medicare oversight and compliance monitoring
- What prior findings prompted the review
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Hospital revenue cycle teams
- Physician practice administrators
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