Health Information Management

News: OIG Work Plan targets review of MS-DRG system, contractor efforts

CDI Strategies, October 11, 2012

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Every October, the Office of Inspector General (OIG) releases its Work Plan for the upcoming fiscal year (FY). The Work Plan provides brief descriptions of investigations the agency plans to initiate of programs within the Department of Health and Human Services (HHS).

New on its agenda is a review of the MS-DRG system. The OIG says it will review the billing of inpatient stays since MS-DRG implementation in FY 2008. According to the Work Plan, the OIG “will describe how billing for inpatient stays in FY 2012 varied among different types of hospitals and how hospitals ensure compliance with Medicare requirements for inpatient billing.”

Also new on the OIG’s list is a review of billing for mechanical ventilation to review whether patients received fewer than 96 hours of mechanical ventilation.
Several new items on the OIG’s Work Plan focus on review of CMS’ oversight of its contractors.
One topic “Overview of CMS’s Contracting Landscape,” states that CMS awarded $4 billion in contracts in FY 2009 and that the Government Accountability Office (GAO) found “pervasive deficiencies” in how CMS manages its control over contractors.
“Given the number of contracts and the obligated dollars for which CMS is responsible, oversight and monitoring are vital for ensuring effective programs,” the Work Plan states.
The OIG also plans to review CMS’ efforts to reduce errors and “assess CMS’ oversight of the process and determine the extent to which it affects overall contractor evaluation.” And it plans to examine CMS assessment and monitoring of its Medicare Administrative Contractors’ performance.
Hospital readmissions and  inpatient versus outpatient and observation services billing are among a few items remaining under OIG scrutiny in FY 2013.
When reports are issued, they are posted to OIG's website. OIG's email list subscribers automatically receive notification when new reports are posted to the website.

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