Tag Archives | Audits

Aggressive Tactics by Third Party Auditors Should Make Providers Vigilant

The goal was to avert fraud, waste, and abuse. We all support that – we collectively pay for Medicare, and who likes throwing their money away? Let’s review the ideal: the patient receives excellent medical care, the provider does a good job documenting that care, the coder translates the documentation into codes that are submitted […]

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Orthopedic Group Pays Big Fine for HIPAA Violation

Raleigh Orthopaedic Clinic of North Carolina has agreed to pay $750,000 to settle charges that it might have violated the HIPAA Privacy Rule by disclosing protected health information

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Move Provider Signature To The Top Of Your Documentation

Checklist Extra: The physician’s credentials have a role to play, too.

Your CPT® coding may be spick and span, but if you fail to fulfill your physician signature requirements, your claims could end up in hot waters because not following these rules can trigger audits and other compliance headaches. Getting your provider to sign your patient’s charts is a basic documentation prerequisite that calls for your relentless compliance.

Basic: The treating physician’s signature serves as a legible identifier for the provided/ordered services. Payers require that the signature must be present in the documentation that comes with your claim.

Check out the following Q&A and find out why stamped signatures just won’t do you any good.

Get to the Bottom line Of Handwritten vs. Electronic Signatures

Question 1: Some of our physicians use handwritten signatures on their charts and others prefer electronic signatures. Is either kind acceptable?

Answer 1: According to CMS,, “Medicare requires a legible identifier for services provided/ordered.” That “identifier” — or signature — can be electronic or handwritten, as long as the provider meets certain criteria. Legible first and last names, a legible first initial with last name, or even an illegible signature over a printed or typed name are acceptable. You’re also covered if the provider’s signature is illegible but is on a page with other information identifying the signer such as a typed name.

“Also be sure to include the provider’s credentials,” says Cindy Hinton, CPC, CCP, CHCC, founder of Advanced Coding Solutions in Franklin, Tenn. “The credentials themselves can be with the signature or they can be identified elsewhere on the note.”

Example: Pre-printed forms might include the physician’s name and credentials at the top, side, or…

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Recovery Audit Contractors: Know These RAC Fast Facts

RACs are just another tool in the government’s arsenal to collect improper payments.

You’ve got so many compliance acronyms flying at you every day that you may not be able to differentiate your RAC from the OIG. Know these quick facts about RACs to stay better informed.

  • Recovery audit contractors (RACs) detect and correct past improper payments so CMS and the MACs can prevent such problems in the future
  • RACs are hired as contractors by the government, and they can can collect “contingency fees,” which means that they get a percentage of the amount that they recover from providers who were paid inappropriately The maximum RAC lookback period is three years, and they cannot review claims paid prior to Oct. 1, 2007
  • Between 2005 and 2008, RACs involved in the original demonstration project recovered over $1.03 billion in Medicare improper payments, but referred only two cases of potential fraud to CMS, according to a February OIG report on the topic, which noted that “because RACs do not receive their contingency fees for cases they refer that are determined to be fraud, there may be a disincentive for RACs to refer potential cases of fraud.”
  • Unlike RACs, the OIG is a government entity. Although the OIG also performs reviews and audits and seeks improper payments, the OIG does not collect contingency fees.

For more on the RAC program, visit www.cms.gov/rac.

Part B Insider. Editor: Torrey Kim, CPC

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Auditors Review Your Notes Based on the Regs as of the Service Date

auditorIf you performed a consult in 2006, the auditor will use 2006 guidelines — not today’s rules.

Most Part B practices have grown accustomed to tucking consult regulations into the backs of their minds, since Medicare no longer pays for…

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Audits: HDI RAC Targets TC, Modifier 26 & More

Want to know what RAC contractors will be looking for next? Here’s the link.
Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well.
Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved […]

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