tci Medicare Compliance & Reimbursement - 2015 Issue 20

Error Rates: Questionable Billing Seems to Have A Geographic Pattern

OIG advise CMS to closely monitor ophthalmology claims. The HHS Office of the Inspector-General (OIG) recently performed a study on the billing trends of ophthalmology practices. The findings should make you sit up and take notice, especially if yours is an ophthalmology practice and is situated in West Virginia or New Jersey. Background: The OIG evaluated whether ophthalmology services are vulnerable to fraud, waste, and abuse after noting that ophthalmologists collected $6.7 billion for wet age-related macular degeneration (wet AMD) and cataracts in 2012 alone. As part of the study, which was published last week under the name...

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