Tag Archives: Scrutiny
Place-of-Service Codes Caused $13 Million in Overpayments
Double check POS 11 shouldn’t be 22 — or 24.
Entering your place-of-service (POS) number on your claim form may seem routine, but a recent OIG audit found that practices are not giving POS numbers the care they deserve.
Based on a r… Continue reading
Compliance: Curb Upcoding Mistakes Or Risk OIG Scrutiny
Practice size does not matter when dealing with compliance — even solo practitioners have to stay on the straight and narrow.
Even small dermatology practices have to stay compliant with government regulations — and although this sounds like a simple fact, it’s one that many Part B providers may overlook.
Ensuring physician practice compliance can be a complex path, and many practices think of it is something that large hospitals should focus on — after all, those are the entities that get all of the media exposure when they violate compliance rules. But every practice is responsible for compliance, no matter how big or small.
Doctors Take Note
In some cases, small practices think compliance rules don’t affect them — but also don’t realize they’re at risk of being noncompliant.
Example: “I met with a solo practitioner a few years ago who hired me as a consultant,” says Laura E. Hill, CPC, CPC-I, an Arizona- based compliance consultant.
“It was my sad duty to let him know that his office manager,who submitted all of his claims, was upcoding all of his office visits as she entered them into the computer so that she could pay his quarterly malpractice-insurance premiums,” Hill says. “She had been working for him for 10 years and was a loyal and trustworthy employee.”
The fault was the physician’s, because he never took the time to review the monthly reports that the office manager gave to him, Hill says. He also never looked closely at his deposits into his corporate checking account, where there was an obvious trend toward increased deposits every third month.
Pay attention to your advisors: In the example above, the physician’s accountant had pointed the problem out to him, “but he accepted his office manager’s explanation that insurance…
OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage
Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.
If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.
Append 59 [...]
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Global Billing: Document ‘Unrelated’ for Modifier 79 Services
MACs are looking for ‘red flags’ to halt additional global period pay
Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.
After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt [...]
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