Each month, we are pleased to share the most recent additions to the Office of Inspector General (OIG) Work Plan items. Starting in June, OIG has been updating their Work Plan monthly with any new changes to the active list. Let’s take a look at the new points from this month!

A few topics that stood out to us for November’s OIG Work Plan are the following:

  1. Medicaid Services Delivered Using Telecommunication Systems
  2. Medicare Claims on Which Hospitals Billed for Severe Malnutrition
  3. Use of Funds by Medicaid Managed Care Organizations

Find the full list of Recently Added Items on OIG’s site. Curious where to find last month’s added items? Take a look at October OIG Work Plan Updates.

This month’s agenda is relatively small from OIG with only 4 new items. Let’s walk through some of these updates so you can address each item within your compliance program.

Medicaid Services Delivered Using Telecommunications Systems

In the era of mobile Q&A and instant information at our fingertips, healthcare services are quickly becoming more adaptable to popular delivery. At this time, there may not be another mechanism more popular than telehealth. With the rising increase in Medicaid telehealth payments, OIG is taking a closer look at how Medicaid payments are being distributed for areas such as telemedicine, telehealth, and telemonitoring services.

These services are delivered in a variety of ways – mostly through interactive video, data transmission, or audio telecommunications. Don’t expect these services to slow down in the future, and expect a heightened emphasis from OIG for holding each state accountable.

Read the full update from OIG here.

Medicare Claims on Which Hospitals Billed for Severe Malnutrition

When severe malnutrition occurs among Medicare patients, it is classified as a major complication or comorbidity (MCC). Unfortunately, this problem continues to grow as the population continues to age and a variety of treatment or conditions remain inadequate for optimal care.

OIG will be reviewing the accuracy of Medicare payment for the treatment of this serious issue among many patients who are classified as an MCC, because of the increased costs associated with this claim.

Read more on this issue here.  

Use of Funds by Medicaid Managed Care Organizations

In 2015, federal managed care payments accounted for more than 40% of the total federal expenditures for Medicaid ($349.8 billion). These organizations can be characterized as a system set up to manage quality, cost, and utilization.

Individual states are expanding their use of such organizations (MCOs) each year, and OIG will be evaluating the relationships and funding between Medicaid and Managed Care Organizations.

To get more information on how these measures are being taken, read on further here.

Do you have any recent experience or background information concerning OIG’s Work Plan updates for November? Let us know in the comments below!

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Written by Michael Rosen, ESQ

ProviderTrust Co-Founder, mrosen@providertrust.com

Michael brings over 20 years of experience founding and leading risk mitigation businesses, receiving numerous accolades such as Inc Magazine’s Inc 500 Award and Nashville Chamber of Commerce Small Business of the Year.

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