Audit / Hot Coding Topics / Oig / RAC / radiology

Double Ultrasound Codes Spell Double Trouble With Auditors

Authorities scrutinize medical necessity for 76830 & 76856. The OIG is watching your ultrasound orders and code combinations — and it doesn’t like what it sees. Take note of these problem spots to keep your claims in the clear. An OIG audit of ultrasound services billed in 2007 found that nearly one in five ultrasound claims “had characteristics that raise [...] Related articles:

  1. OB or Not OB: That’s the Ultrasound Coding QuestionQuestion: For an ultrasound, the radiologist documented measurements of the uterus,...
  2. New From CPT Assistant: Help with Trunk Ultrasound Coding Do you know exactly what’s in the mediastinum? Your US...
  3. OIG Auditors to Cardiologist: You’re Billing Medicare ProperlyReport reveals what he and his billing staff did right....

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October 24, 2009
RAC / radiology / Toolkit

Radiology Billing Checklist: Rules for Additional Tests without Treating Physician’s Order

Keep these additional test rules at your fingertips if your want to keep auditors out of your hair. The Office of Inspector General and Recovery Audit Contractors are out to audit non-compliant ultrasound claims, so knowing the rules is more important than ever. And we’ve got a link and a handy checklist to keep you out [...] Related articles:

  1. OIG Slaps Radiology Practice With Record $2 Million PenaltyThink it’s okay to provide diagnostic tests without physician orders?...
  2. Documentation Checklist for Complex Radiology Treatment Planning (77263) Think you know all you need to know about...
  3. 3 Big Fee Schedule Changes for Radiology Coding & BillingCapture additional $2,305 for Bilateral 50593 by Applying Fee Schedule...

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October 21, 2009
Audit / Cardiology / Oig / Provider News

OIG Auditors to Cardiologist: You’re Billing Medicare Properly

Report reveals what he and his billing staff did right. Does your practice have the right stuff? Turns out the old saying is true: If you haven’t done anything wrong, an OIG audit is nothing to worry about. A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG’s [...] Related articles:

  1. Double Ultrasound Codes Spell Double Trouble With AuditorsAuthorities scrutinize medical necessity for 76830 & 76856. The OIG...
  2. Medicare Fraud Fighter Reveals 9 Billing Patterns That Draw HEATA Department of Justice senior trial attorney behind the widely...
  3. HHS Plans to Crack Down on Fraud, Improper BillingMedicare loses $60 billion a year in improper payments. A...

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October 20, 2009
Audit / Hot Coding Topics / Oig

Service Doesn’t Meet Incident-To Rules? Report Under NPP’s NPI

Heads up: These vaccine admin codes are excluded from incident-to requirements. Incident-to rules don’t always apply to diagnostic services, but many medical practices aren’t aware of that. And based on a new wave of scrutiny directed toward incident-to claims, you should know physician supervision rules inside and out. A recent audit from the HHS Office of the Inspector [...] Related articles:

  1. Nonphysician Providers and Incident-To: Your Coding Questions AnsweredHere’s why you should keep your physicians’ work schedules on...
  2. Use This Incident-To Checklist to Breathe Easy During an Audit You don’t need to second-guess the way you bill...
  3. 5 Rules Pinpoint Date of Service for Laboratory ClaimsTip 3: Here’s DOS advice for archived samples. You can’t...

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October 20, 2009
Audit / MAC / modifier GY / Provider News / RAC

A Physician Coder’s Guide to the 2010 OIG Work Plan

If your practice does lab panels, sleep studies, hospice visits and more, take heed. The HHS Office of Inspector General has published its 2010 Work Plan, which should give us all a heads up on what the watchdog agency will be auditing and evaluating this year. Why you should care: The 115-page document is like a map [...] Related articles:

  1. Proposed 2010 Physician Fee Schedule: A Closer Look21.5 percent cut looms for your services Last week, Coding...
  2. New PQRI, E-Prescribe Tool from CMS If your head is spinning with all of the...
  3. How Obama’s Medicare Cuts Hit Physician Reimbursement  The budget released Thursday suggests we cut $300 billion from...

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October 13, 2009