tci Medicare Compliance & Reimbursement - 2013 Issue 2

Compliance: Tighten Up Documentation, Correct Modifier Use Or Else, Says OIG

Many OIG suggestions ignored according to a report. When the OIG released its Compendium of Unimplemented Recommendations in December, the standout points were that facilities and practices were not heeding its recommendations. One big takeaway for surgical practices is that CMS could save as much as $97 million if it tightened up on global surgery claims inconsistencies. Expect E/M visits to meet tighter scrutiny in 2013. Case in point: In 2009, the OIG found that global surgery fees for eye procedures included a set number of E/M services, but that physicians did not actually provide that many E/M visits...

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