Brief Your CEO: Use New OIG Work Plan to Keep Your Lab Compliant in 2017

As the year comes to a close, lab managers need to brief their officers on the federal government enforcement initiatives that may affect operations in the coming year. The best place to turn for insight into what the feds are thinking is the Health and Human Services Office of Inspector General's (OIG) year-end Work Plan, the bi-annual report in which the agency summarizes its new and ongoing enforcement programs and priorities for the upcoming six months. Here are the nine items in the recently published 2017 Work Plan that you should include in your CEO briefing.

1. Mostly More of the Same for Labs
The OIG has often used the Work Plan to announce major initiatives targeting billing and payment of clinical laboratory services under Part B. But there is nothing like that in the 2017 Work Plan. All of the lab initiatives listed, including those listed as new items, are merely reprises of issues the OIG has raised many times before. Even so, the fact that they appear in the 2017 Work Plan indicates that the OIG continues to regard the matter as an enforcement priority. So make sure you mention these things in your CEO briefing.

2. Billing of Lab Services in 2016
The OIG says it will analyze the top 25 most billed lab tests for 2016 and compare the findings to 2015 and 2014. But while it is listed as a new item, this is something the OIG is required to do every year under Protecting Access to Medicare Act of 2014 (PAMA).

3. Independent Clinical Lab Billing
Review of Medicare payments to independent clinical laboratories with an eye to labs that "routinely submit improper claims" has become a fixture for Work Plans and appears in the 2017 version as well.

4. Histocompatibility Lab Billing
The OIG says it will continue to review payments of tests required for bone marrow and solid organ transplant services and ensure that the cost reports submitted by histocompatibility labs are accurate and detailed enough to support reimbursement.

5. Billing of Diagnostic Sleep Tests
Improper billing of sleep testing by independent and hospital labs, particularly repeat tests performed on the same patient, have become a growing concern for the OIG and have now landed in the Work Plan.

6. Billing and Payment of Hyperbaric Oxygen (HBO) Services
The 2017 Work Plan also includes a handful of new non-lab-specific items that may still have an impact on labs. One of these is OIG review of Medicare payments for HBO outpatient claims to ensure they meet Medicare and National Coverage Determinations Manual requirements (See 20.29(A), page 60) in response to concerns about billing for non-medically-necessary HBO services.

7. Chronic Care Management
The OIG will review Medicare payments for chronic care management services, nonface- to-face services to Medicare patients with multiple significant chronic conditions involving significant risk of death, acute exacerbation/decompensation or functional decline where the significant chronic conditions are expected to last at least 12 months or the patient's death.

8. Post-Death Service Dates
The OIG will review CMS' policies and procedures that ensure that payments are not made for Medicare services ostensibly rendered to deceased individuals.

9. PAMA & MACRA Implementation
OIG will review CMS implementation of not only PAMA but the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) to address "timelines and key milestones CMS has established" for implementation, as well as "key challenges and potential vulnerabilities CMS is facing during implementation."

Takeaway: Even though it is short on new initiatives, it is important to brief your CEO about the ongoing lab billing compliance issues cited in the OIG's newly released 2017 Work Plan.