Review of DRG 72-hour window part of busy OIG work plan - Updata - Department of Health and Human Services' Office of the Inspector General plans lots of activity in 2002 - Brief Article

Healthcare Financial Management, Dec, 2001

The FY02 work plan of the HHS Office of Inspector General (OIG) sets forth an ambitious agenda that could affect most providers through possible regulatory changes, if not directly through compliance reviews. Notably, the OIG plans to consider the merits of expanding the DRG payment window. Such a change could have a profound, long-term effect on institutional providers. In a 1994 review, the OIG found that "the industry practice is to provide preadmission services beyond the current 72-hour payment window."

Many providers feel that the change could lead to administrative headaches, more battles with intermediaries over securing separate payment for diagnostic tests, and compliance problems for entities that currently skirt the payment window as the OIG actively examines current industry practices.

Overall, the work plan lists more than 130 OIG projects for the year, including reviews of the following:

* Home health providers' coding under the home health prospective payment system;

* Nursing homes' compliance with nurse aide training requirements;

* Physicians' evaluation and management (E&M) coding; and

* Clinical laboratories' policies and procedures for proficiency testing under the Clinical Laboratory Improvement Amendments.

The OIG indicated that its work plan would be posted at its Web site in November. Go to http://oig.hhs.org.