tci Medicare Compliance & Reimbursement - 2023 Issue Q3

Industry Notes: Don’t Let Modifier Snafus Impact E/M Claims

One Baltimore-based oncology practice learned the hard way that the feds don’t mess around with inappropriate E/M claims. Scoop: On Sept. 12, Frederick Oncology and Hematology Associates, P.C. (FOHA) agreed to pay the government more than $850,000 to settle allegations the firm had inaccurately billed Medicare for E/M claims using the wrong modifier. Between Jan. 1, 2013 and Nov. 1, 2017, “FOHA improperly submitted claims for evaluation and management using a code modifier that is only appropriate when there is a separate and distinct evaluation and management service on the same day as a procedure...

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