OIG To Review Place-of-Service Errors and Provider-Based Status

October 19, 2009 – In The News
HR Compliance News

In its 2010 Work Plan, the OIG says it wants to evaluate physician coding for place-of-service errors and hospitals claiming provider-based status. With more and more physicians in ancillary arrangements, this OIG scrutiny is worth noting, according to Todd Rodriguez.

“We’ve seen this before,” Rodriguez says. “It stems from the fact that doctors are entering into lots of ancillary arrangements involving surgery centers, or leased services with hospitals in outpatient departments.” Questions arise when physicians lease offices in ASCs, a situation that is becoming more and more popular: “You run into issues where the space that a physician leases falls within the space covered by an ASC license,” he explains.

Along similar lines, physicians who affiliate with hospitals should pay particular attention to the financial ramifications of such arrangements, adds Rodriguez. “The concern for doctors is if they sell their practice to a hospital, their office location may still be considered freestanding for reimbursement purposes,” says Rodriguez. “And if they sell an imaging service, it could still be billed under Part B.”