tci Medicare Compliance & Reimbursement - 2015 Issue 12

Compliance: Invite Attention From Auditors With Missing Medical Records

Lookout for claim viability if your physicians perform these services. Scrutiny of polysomnography claims, which have been known to be replete with mistakes for some time, is rising. On May 20, the HHS Office of the Inspector General (OIG) released a report detailing its audit of sleep study claims paid by Part B MAC First Coast Service Options.  According to the agency, First Coast overpaid practices by a startling $15.7 million for sleep study claims between 2011 and 2012 — and CMS wants that money back. It’s likely that other MACs will be scrutinized for sleep...

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