Payer Utilization Review

Almost all payers are scrutinizing the utilization of services in order to reduce costs. There are several documents that can be helpful in understanding the types of services drawing the most attention.

OIG Work Plan

The conventional wisdom about the effectiveness of billing compliance plans to avoid problems with fraud and abuse emphasizes the need to plan annual employee training based on important risk areas. An excellent source of updated information about potential risks in physician practices is the government reports that identify focus areas for investigation such as the Office of Inspector General (OIG) Work Plan and the program integrity initiatives developed by the Centers for Medicare & Medicaid Services (CMS).

  1. Medicare National Carrier Decisions
  2. MAC Local Coverage Decisions
  3. Newsletters from commercial payer websites

Urology practices must be diligent to remain aware of these issues or risk having prior payments recouped.