Highlights of 2014 OIG Work plan for Hospitals

Healthcare Training Resource
February 21, 2014 — 885 views  
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The Office of the Inspector General released its 2014 fiscal year work plan on January 31st 2014. The work plan outlines the agency’s policy regarding Medicaid, Medicare and various other HHS programs enforcement guidelines. The focal areas will be fraud and abuse prevention, curbing waste and eliminating non- compliance with the program requirements outlined by the government.

Hospitals Should Pay Extra Attention to In-Patient Admissions

There are some key areas which will draw the greatest attention from the OIG and hospitals will need to be extra careful in this respect. The criteria that the hospitals employ to admit patients for treatment has been specified. Now, physicians are instructed to admit patients entitled to Medicare benefits as in-patients only if this kind of hospitalization and care is deemed to be necessary for him or her over the period of a minimum of two midnights. This norm will be deemed as the basis for all billings, Medicare payments and benefit payments that pertain to the patient.

OIG will Oversee Pharma Compounding

The OIG now holds the responsibility of summarizing Medicare’s supervision of pharmaceutical compounding in those hospitals providing  acute care for Medicare beneficiaries. Assessment of pharmaceutical compounding done by hospital accreditors and state regulators will also be reviewed by the OIG.

Reasonable Remuneration for Facility Operations will be Accepted

With respect to the employee compensation component of the hospital’s operating cost that is reimbursed, the OIG has released some guidelines. This remuneration will be deemed ‘reasonable’ for this purpose if it is paid to employees handling managerial, professional, administrative  or any other task that is directly relevant to the functioning of the hospital or patient care. As of now, restrictions have not been specified on the maximums that can be paid in terms of such remuneration.

Emergency Care During Disasters

The OIG will also evaluate how well the hospital is prepared for providing emergency medical care during natural calamities and disasters. This review will be in addition to the hospital’s participation in the emergency programs by the HHS.

In addition to these areas of focus, the OIG will also determine if the new medical staff reviews, quality- of- care appraisals and verification of privileges is  being done adequately. This will ensure that a high standard of medical care is available at all hospitals that are participating in Medicare and similar medical benefit programs. Hospitals should ensure that their systems will pass muster with these new and more stringent requirements outlined by the OIG work plan.

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