Inside Angle

From 3M Health Information Systems

Tag: OIG

Karla VonEschenKarla VonEschen

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Risk adjustment: The pitfalls of inaccurate ICD-10 coding

Jan. 15, 2024 / By Karla VonEschen, MS, CPC, CPMA

If you work with risk adjustment coding, chances are you’ve seen some recent news from the Office of Inspector General (OIG) announcing findings for audits performed. OIG audits aren’t new, […]

Divya VermaDivya Verma

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Medical necessity edits: Example of a limitation

Aug. 21, 2023 / By Divya Verma, RHIA

A recent Office of Inspector General (OIG) report on Medicare’s utilization of one of the highest paid molecular pathology genetic tests caught my attention. You can read a summary of […]

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The OIG and DOJ expect compliant HCC documentation

Jan. 31, 2022 / By Chris Berg, RHIA

As a clinical documentation integrity (CDI) and coding professional, I’ve often heard the statement: If it’s not documented, it wasn’t done. I have used this statement educating physicians and nurses […]

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Red Flag: OIG chart reviews of Medicare Advantage records raise concerns. Billions misspent?

Feb. 14, 2020 / By Barbara Aubry, RN

Audits of Hierarchical Condition Categories (HCCs) have been performed for years as a way for Part C vendors (Medicare Advantage Organizations) to identify and support patients with complex needs. Higher […]

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Eyes on Eylea and Lucentis

Aug. 9, 2019 / By Divya Verma, RHIA

Recently, I came across an OIG announcement “Review of Medicare Part B Claims for Intravitreal Injections of Eylea and Lucentis” released in June 2019. Upon reading this announcement, I pulled […]

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The importance of medical necessity compliance: Recent actions by the U.S. Attorney’s Office and the OIG

July 16, 2018 / By Barbara Aubry, RN

I’ve been talking about this for years. I still see folks who don’t think compliance with medical necessity polices is critical. Believe me, I understand human nature; noncompliance can be […]

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Caution ahead: Coding of right heart caths (RHC) with a biopsy

May 2, 2018 / By Rebecca Caux-Harry

At AAPC’s annual Healthcon conference in Orlando, Florida, Dr. David Zielske (also known as Dr. Z) had a session on Interventional Radiology, Cardiology and Vascular Surgery coding. As you can […]

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Fallout from the opioid crisis or improper coding?

March 7, 2018 / By Barbara Aubry, RN

I review OIG updates as they are released and I saw something last week that unfortunately, I did not find surprising. Per the OIG report: “Payments made to providers for […]