Billings with modifier GY for uncovered services. The OIG will examine patterns and trends in use of the -GY modifier for services that are not covered by Medicare to determine whether they are appropriate. In fiscal year 2008, Medicare received more than 75.1 million claims with the -GY modifier for $820 million in charges. Beneficiaries are liable, either personally or through other insurance, for these charges.
Payments for unlisted procedure codes. The OIG will review the accuracy of payments for services using unlisted procedure codes, which are to be used only when there is no HCPCS code available. Medicare contractors put unlisted procedure codes under individual review and manual pricing.
Physicians’ services performed by nonphysicians. The OIG will review “incident to” services, which physicians bill but do not perform personally. “These services may be vulnerable to overutilization or put beneficiaries at risk of receiving services that do not meet professionally recognized standards of care,” the Work Plan states. “We will examine the qualifications of nonphysician staff that perform ‘incident to’ services and assess whether these qualifications are consistent with professionally recognized standards of care.”
Evaluation and Management services during global surgery Periods. The OIG will review the number of E&M services reimbursed as part of the global surgery fee to determine whether industry practices have changed since the concept was developed in 1992.
Learn more about the 2010 OIG Work Plan.
