Early last fall, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released its OIG Work Plan for fiscal year 2018–2019, which is a two-year framework for the audits, inspections, evaluations and investigative activities planned in support of its vision, mission, and strategic goals and objectives to maintain HHS program integrity. The OIG continues to look at key areas that affect quality patient care and outcomes, and determined it would be more beneficial to release their projects work on an ongoing basis instead of biannual updates. The OIG considers several factors when creating Work Plan items, including legal mandates, congressional requests, budgetary concerns, as well as the potential for positive impact. The new format will include an ongoing list of active work plan items, which will comprise newly initiated Work Plan items and notifications of completed items.
Key areas of potential risk that rheumatology practices should be aware of include the following:
Financial Impact of Health Risk Assessments & Chart Reviews on Risk Scores in Medicare Advantage
Payments to Medicare Advantage (MA) organizations are risk adjusted, based on beneficiary information, to determine which MA organizations have higher expected costs. Health risk assessments and chart reviews are an integral part of this process. The OIG seeks to determine which diagnoses solely generated by their integral process correlate with high- and low-risk scores and payments.