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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

HHS OIG Releases FY 2013 Work Plan

October 5, 2012—The Department of Health and Human Services (HHS) Office of Inspector General (OIG) Oct. 2 issued the 2013 Work Plan.

The Work Plan provides a brief description of ongoing and new projects that the OIG will undertake, and for each project provides an estimate of when a report will be issued.  The information provided in the Work Plan is one tool that institutions use to identify potential risk areas or potential changes to Medicare reimbursement.

Among the new projects are:

  • An analysis of claims data to determine how much the Centers for Medicare and Medicaid Services (CMS) could save if it bundled outpatient services delivered up to 14 days prior to an inpatient hospital admission into the diagnosis related group (DRG) payment. Medicare currently bundles all outpatient services delivered 3 days prior to an inpatient hospital admission. Prior OIG work identified improper payments in the DRG window. OIG work also has concluded that CMS could realize significant savings if the DRG window was expanded from 3 days to 14 days;
  • A determination of the impact of non-hospital-owned physician practices billing Medicare as provider-based physician practices; and,
  • A review of Medicare payments made to hospitals for beneficiary discharges that should have been coded as transfers. The OIG plans to determine whether such claims were appropriately processed and paid.

Contact:

Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499
Email: ibaer@aamc.org

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For More Information

Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org