The 2022 OIG Work Plan: Implications for Anesthesia Practices
Every year, the government's watchdog agency produces a list of healthcare services and procedures they plan to scrutinize for the purpose of determining the potential for significant abuse by the provider community. The 2022 list contains a few items that will be of interest to anesthesia and chronic pain providers.
There is an age-old teaching that adjures us to sit down and plan out our work before putting hammer to nail. What is the desired outcome? How much will it cost? What tools will be needed, and how much time must be invested? Measure twice and cut once is another way to describe this principle. And, of course, once you have planned the work, then you must work the plan. So much for the well worn folk wisdom and ancient adages, but all this leads us to say that there are those in the halls of government who take this ethic very seriously. Each and every year, they publish a plan outlining their projected work product over the coming months, and that work product involves the review of healthcare claims.
As most of our readers know, the U.S. Department of Health and Human Services (HHS) includes multiple agencies, offices and programs, such as the Centers for Medicare and Medicaid Services (CMS) and the National Correct Coding Initiative (NCCI), among others. The Office of Inspector General (OIG) is also a part of the HHS family and acts as the watchdog agency for the Department. Their mandate is to investigate and eradicate fraud, waste and abuse connected with federal healthcare programs, such as Medicare and Medicaid. As part of this process, the OIG publishes each year its work plan for the upcoming fiscal year. The work plan contains areas that the agency intends to focus on due to information it has received that may indicate a potential for improper billing on the part of healthcare providers or suppliers. The OIG work plan for 2022 contains over 250 areas of concentration. We thought it might be instructive to point out the few areas that may directly or tangentially affect those in the anesthesia community.
Spinal Pain Management
The first focal point arising from the OIG work plan that will have a potential impact on our readers is pain management procedures involving the spine. You may recall that, in recent months, we provided you with alerts that addressed Medicare's intention to make it more difficult to get paid for providing anesthesia services in connection with facet joint interventions and various chronic pain epidural injections. Now, the OIG is intent on closely monitoring the billing of these and other pain management procedures and their related sedation services. According to the OIG work plan:
Medicare Part B covers various spinal pain management services including facet joint injections, facet joint denervation sessions, lumbar epidural injections, and trigger point injections. Medicare Part B also covers sedation administered during these pain management services. We will audit whether Medicare payments for spinal pain management services billed by physicians complied with Federal requirements.
The work plan goes on to state:
Facet joint injections are an interventional technique used to diagnose or treat back pain. Several previous reviews found significant billing errors in this area, including a prior OIG review. We will review whether payments made by Medicare for facet joint procedures billed by physicians complied with Federal requirements (Social Security Act, § 1833(e), 42 CFR § 424.32(a)(1), and 42 CFR §414.40).
Critical Care
The second area of OIG focus in 2022 will be critical care services. Here is how the agency introduces its intention to review these types of cases:
Critical care is defined as the direct delivery of medical care by a physician(s) for a critically ill or critically injured patient. Critical care is usually given in a critical care area such as a coronary, respiratory, or intensive care unit, or the emergency department. Payment may be made for critical care services provided in any location as long as the care provided meets the definition of critical care. Critical care is exclusively a time-based code. Medicare pays physicians based on the number of minutes they spend with critical care patients. The physician must spend this time evaluating, providing care and managing the patient's care and must be immediately available to the patient. This review will determine whether Medicare payments for critical care are appropriate and paid in accordance with Medicare requirements.
As our readers are already aware, the 2022 Medicare Physician Fee Schedule (PFS) Final Rule contained a few changes to how critical care cases should be documented, counted and submitted. It will be important, therefore, to brush up on these new requirements, knowing that the OIG is closely monitoring the billing of these services this year.
Inadequate Diagnoses
One of the items we discuss in our client compliance training sessions is the importance of providing accurate and complete diagnosis descriptions on the anesthesia record. Even where an electronic medical record (EMR) is auto-populating this data, it is still up to the anesthesia provider to ensure the record reflects the correct postoperative diagnosis. The OIG has targeted diagnosis documentation in Medicare Advantage cases, specifically, for 2022. Here is the agency's description of their intent in this regard:
Centers for Medicare & Medicaid Services estimates that 9.5 percent of payments to Medicare Advantage organizations are improper, mainly due to unsupported diagnoses submitted by Medicare Advantage organizations. Prior OIG reviews have shown that medical record documentation does not always support the diagnoses submitted to Centers for Medicare & Medicaid Services by Medicare Advantage organizations. We will review the medical record documentation to ensure that it supports the diagnoses that Medicare Advantage organizations submitted to Centers for Medicare & Medicaid Services for use in Centers for Medicare & Medicaid Services's risk score calculations and determine whether the diagnoses submitted complied with Federal requirements.
Telehealth Services
As we are all aware by now, telehealth or virtual medical services have become increasingly popular over the last two years, especially with the advent of the COVID pandemic. The government issued new rules and waivers of old rules to allow for doctors and patients to "see" each other without having to be in the same facility. Naturally, with the increased usage of these services, the OIG is curious as to how well providers are meeting the regulatory and coding conditions to bill such services. To that end, the OIG 2022 work plan states the following:
Because of telehealth's changing role, we will conduct a series of audits of Medicare Part B telehealth services in two phases. Phase one audits will focus on making an early assessment of whether services such as evaluation and management, opioid use disorder, end-stage renal disease, and psychotherapy (Work Plan number W-00-21-35801) meet Medicare requirements. Phase two audits will include additional audits of Medicare Part B telehealth services related to distant and originating site locations, virtual check-in services, electronic visits, remote patient monitoring, use of telehealth technology, and annual wellness visits to determine whether Medicare requirements are met.
Providers of telehealth will want to refer back to our alerts dealing with how to properly conduct and document these services, knowing that the OIG is taking a close look at telehealth cases in 2022.
To refresh your understanding of how to meet the requirements of the services listed in the OIG work plan, you can refer to our catalog of previous articles at Anesthesia Provider News eAlerts. Alternatively, you can always reach out to your account executive if you have specific questions about the above OIG target areas, or you can connect with us at info@anesthesiallc.com.
With best wishes,
Tony Mira
President and CEO