Medical Auditing Practice Exam

Where can information regarding potential reviews by the OIG be found following the significant increase in Medicare payments for Stelara beginning November 2019?

1. OIG Compliance Manual

2. OIG Annual Report

3. OIG Work Plan

4. Medicare Physician Fee Schedule

The correct answer is: OIG Work Plan

The correct choice provides access to information specifically designed to highlight the areas of focus for the Office of Inspector General (OIG), including potential reviews related to healthcare services and payments. The OIG Work Plan outlines the various projects and reviews the OIG plans to conduct during the fiscal year, and it typically reflects any recent changes in regulations and payments, such as the increase for Stelara. The OIG Work Plan is crucial for medical auditors as it gives insights into current oversight priorities, which can help healthcare providers understand where auditing scrutiny may be placed and adjust their compliance strategies accordingly. This enables organizations to stay ahead of potential issues that might arise from increased payments and ensures they are adhering to proper billing practices. While the OIG Compliance Manual provides guidance on compliance program requirements and practices, it does not specifically address ongoing or future reviews. Similarly, the OIG Annual Report summarizes prior years' activities but does not focus on upcoming reviews. The Medicare Physician Fee Schedule provides information on payment rates but does not indicate which services will be reviewed for compliance or oversight. Therefore, the OIG Work Plan is the most relevant source for insights into potential reviews relating to the increased Medicare payments for Stelara.