Hospital Utilization Review Stakeholder Meeting Office of Inspector - - PowerPoint PPT Presentation

OIG Fraud Hotline: 800-436-6184 1

Hospital Utilization Review Stakeholder Meeting

Office of Inspector General Medicaid Program Integrity Division Medical Services

January 21, 2020

Office of Inspector General (OIG) Reviews

OIG Fraud Hotline: 800-436-6184 2

• Review of Emergency Room /

Outpatient Claims associated with Inpatient Stays

SharePoint Update

OIG Fraud Hotline: 800-436-6184 3

• Use of the SharePoint External

Transfer Site continues to increase.

• To request access, send an email to
• igsharepoint@txhhs.onmicrosoft.com

and tell us: who you are, the

• rganization you represent, and why

you need access. Action on your request maybe delayed, if this information is incomplete.

Samples

• The next Fee-For-Service Sample

will be released in February 2020.

• Development of the next Managed

Care Sample is planned to begin in February.

OIG Fraud Hotline: 800-436-6184 4

Managed Care Organization Update

OIG Fraud Hotline: 800-436-6184 5

• A request to the MCOs was sent on

December 20, 2019 requesting payment methodology for potential denials for the first sample.

Coding Trends

• Use of code P00.2 Newborn (suspected

to be affected) by maternal infectious and parasitic diseases.

• 0CB7XZZ Excision Of Tongue External

Approach vs 0CN7XZZ Open Release Of Tongue Tie

OIG Fraud Hotline: 800-436-6184 6

To Learn more about the Office of Inspector General: Website: ReportTexasFraud.com Facebook: www.facebook.com/TxOIG Twitter: twitter.com/TexasOIG

OIG Fraud Hotline: 800-436-6184 7

Thank You

Johanna Fite-Sagredo RN, BSN Manager V Hospital/Lock-In Program Medical Services, Medicaid Program Integrity

Johanna.Fite@hhsc.state.tx.us OIG_UR@hhsc.state.tx.us