In its December 18, 2023, Enforcement listserv notice, HHS’s Office of Inspector General (“OIG”) published its Work Plan Updates for December. Although six updates were published, this article will only highlight the following:

Audit of Medicare Payments for Emergency Department Services Provided in Nonemergency Department Sites of Service

This audit will determine whether Medicare appropriately paid hospitals and physicians for emergency department services provided in nonemergency department sites of service. The audit will be conducted by OIG’s Office of Audit Services, with a report expected in federal Fiscal Year 2024 (ends on September 30, 2024).

The Work Plan announcement identified that certain Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes should be used only if a Medicare enrollee is seen in the emergency department and the services described by the codes’ definitions are provided. Medicare reimburses providers based on the patient’s documented service needs at the time of the visit and based on the site of service. It is expected the audit will address the applicable billing codes and compare them with the location of service (e.g., emergency department or nonemergency department) and assess if the services provided were within the scope of the codes’ requirements.

A full summary of the Audit Work Plan Updates is accessible for those interested.

Should you need anything else on this topic or if you have a matter you wish to pursue with NYSDOH or OIG, please reach out to Matthew Babcock at mbabcock@harrisbeach.com to discuss an engagement.

This alert is not a substitute for advice of counsel on specific legal issues.

Harris Beach has offices throughout New York state, including Albany, Buffalo, Ithaca, Long Island, New York City, Rochester, Saratoga Springs, Syracuse and White Plains, as well as Washington D.C., New Haven, Connecticut and Newark, New Jersey.