Tag Archives | Scrutiny

Place-of-Service Codes Caused $13 Million in Overpayments

Double check POS 11 shouldn’t be 22 — or 24.

Entering your place-of-service (POS) number on your claim form may seem routine, but a recent OIG audit found that practices are not giving POS numbers the care they deserve.
Based on a r…

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OIG Hit List: Perfect Your 38220, 38221, and G0364 Usage

Don’t sweat reporting 38220-59 if you meet these Medicare-approved conditions.
If your oncologist takes both a bone marrow biopsy and a bone marrow aspiration, whether you’ll see Medicare reimbursement depends on the two guidelines below. But watch out: With OIG scrutiny and a HCPCS twist, these guidelines will put your coding savvy to the test.
Append 59 […]

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Global Billing: Document ‘Unrelated’ for Modifier 79 Services

MACs are looking for ‘red flags’ to halt additional global period pay
Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.
After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt […]

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