Connecting all the compliance and reimbursement dots in Diagnostic Radiology medical coding, billing and collections is a veritable maze these days. Maintaining a razor sharp focus on the priorities and newest changes in Diagnostic Radiology compliance regulations is critical.

According to the November 2012 journal Radiology, many practices [including in-house Diagnostic Radiology revenue cycle management teams] are unaware of the critical link between diagnosis coding and procedural coding systems and the systems that have developed to provide a common method of describing diseases, diagnoses, and procedures.

Diagnostic Radiology is included in the 2013 OIG Work Plan, specifically Medical Necessity of High-Cost Tests. The OIG will review Medicare payments for high-cost diagnostic radiology tests to determine whether they were medically necessary and the extent to which the same diagnostic tests are ordered for a beneficiary by primary care physicians and physician specialists for the same treatment.

In addition, Radiology states, “The 2013 OIG Work Plan includes reference to the appropriateness of current practice expense payments for selected Part B imaging services. The OIG plans to study the expenses incurred by providers to see whether current assumed imaging utilization rates reflect actual industry practices.

“Secondly, the OIG plans to look closely at the medical necessity of ‘high-cost’ diagnostic radiology tests and review whether there is a difference between primary care physicians and specialists in how often they order the same diagnostic tests for the same treatment.

“In addition, the OIG plans to continue making use of analytics like computer matching and data mining to detect billing irregularities that could be fraudulent. ‘Error-prone’ Medicare providers—providers who have consistently submitted claims found to be in error over a 4-year period—will find their claims scrutinized especially closely. The OIG plans to ‘select the top error-prone providers on the basis of expected dollar error amounts and match the selected providers against the National Claims History file to determine the total dollar amount of claims paid.’ It then promises to perform medical reviews on a sample of those claims to look for fraudulent billing.”

revMD is prepared to help Diagnostic Radiology revenue cycle management understand the new OIG Work Plan designed to fight waste, fraud and abuse in Medicare, Medicaid and more than 300 other HHS programs.

Formerly known as Asterino & Associates, revMD is the results-proven alternative for Diagnostic Radiology revenue cycle management based just east of Phoenix, Arizona. They specialize in compliance, maintaining strict adherence to OIG regulations and all the changes in Diagnostic Radiology coding, billing and collections.

Any more, it takes an industry insider with the experience that only builds when your services have responded to the specific Diagnostic Radiology revenue cycle management needs for many years.

For further OIG Work Plan details: Download a PDF of the 2013 OIG Work Plan.

About the Author