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Your One-Stop Free Source for Medical Billing, Coding, Claims
Reimbursement and Medical Office Management Information
Reimbursement and Medical Office Management Information
| Providing free resources and useful informations for Physicians, Office Managers, Medical Billers and Medical Coders |
| OIG's 2011 Work Plan - to Review Place of Service Errors, Payments for Evaluation and Management Services, IDTF Sleep Testing Facility and Outpatient Therapy Services Rendered by Independent Therapist |
| Read What's NEW on MY BLOG |
Reading the 2011 OIG Work Plan -- here are some services that I would
like to share here on my blog about their plans and their ongoing reviews.
Place of Service Errors:
As part of 2011 OIG's Work Plan, they will review for Medicare Part B
claims services rendered at the ASC and hospital setting versus the office
place of service. Medicare pays more amount of reimbursement if the
place of service is office (11) than with the services rendered at the ASC
or hospital setting.
They will review these place-of-service errors and will review if physicians
are properly coding the place of service.
Payments for Evaluation and Management E/M Services:
They will review payments inappropriateness for E/M services and the
constinecy of E/M medicare review determinations. As per CMS guidelines,
"documentation should support the level of service reported". They will
also revier the use of EHR documentation associated with E/M services for
possible multiple services for the same providers and beneficiaries.
Therapy Services in an outpatient setting rendered by Independent
Therapists continually being reviewed by OIG as part of their 2011 Work
Plan. Previously, OIG has indentified claims that were not medically
necessary or lacks of medical documentation. They will identify
independent therapists who have high utilization rate for outpatient
physical therapy services and would determine if the services rendered
were billed to Medicare is compliant with Federal requirements.
Sleep IDTF (Independent Diagnostic Testing Facility) are also under
scrutinity. Previously reviewed that improper payments were caused by
some modifiers not reported with the sleep test.
Sources: 2011 OIG Work Plan, CMS Manuals, Medicare MLN Matters
Articles
like to share here on my blog about their plans and their ongoing reviews.
Place of Service Errors:
As part of 2011 OIG's Work Plan, they will review for Medicare Part B
claims services rendered at the ASC and hospital setting versus the office
place of service. Medicare pays more amount of reimbursement if the
place of service is office (11) than with the services rendered at the ASC
or hospital setting.
They will review these place-of-service errors and will review if physicians
are properly coding the place of service.
Payments for Evaluation and Management E/M Services:
They will review payments inappropriateness for E/M services and the
constinecy of E/M medicare review determinations. As per CMS guidelines,
"documentation should support the level of service reported". They will
also revier the use of EHR documentation associated with E/M services for
possible multiple services for the same providers and beneficiaries.
Therapy Services in an outpatient setting rendered by Independent
Therapists continually being reviewed by OIG as part of their 2011 Work
Plan. Previously, OIG has indentified claims that were not medically
necessary or lacks of medical documentation. They will identify
independent therapists who have high utilization rate for outpatient
physical therapy services and would determine if the services rendered
were billed to Medicare is compliant with Federal requirements.
Sleep IDTF (Independent Diagnostic Testing Facility) are also under
scrutinity. Previously reviewed that improper payments were caused by
some modifiers not reported with the sleep test.
Sources: 2011 OIG Work Plan, CMS Manuals, Medicare MLN Matters
Articles
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