tci Medicare Compliance & Reimbursement - 2004 Issue 42

Enforcement Watch: Wrong Place, Wrong Code? Big Fines

Location is everything when it comes to Medicare claims.Payors are under increasing pressure to weed out claims with incorrect place of service codes - and take money back from the physicians who billed them.In an audit issued Oct. 22, the HHS Office of Inspector General estimated that Wisconsin Physicians Service Insurance Corporation had made $742,510 in Medicare Part B overpayments to physicians for incorrectly coded services. According to the report, 79 of 100 sampled physician services were actually performed in a facility, such as an outpatient hospital department or a freestanding ambulatory surgical center, but were...

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