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:

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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 eye due to a “high volume of Medicare claims in comparison to other cardiologists throughout New York state,” according to the OIG’s report on the topic, which was released on Oct. 14.

The OIG reviewed the cardiologist’s records for the three-year period, but found that the physician, who specialized in non-invasive procedures, complied with Medicare reimbursement requirements. Therefore, the OIG made no recommendations and did not request any fund recovery from the physician.

What your practice can learn: If you have a physician who specializes in a particular condition or procedure and treats lots of Medicare patients, the feds’ data mining techniques may very well flag your practice for an audit. But if your coding and documentation are correct, you can breathe easier as your physician does what she does best.

How the audit worked: The OIG audited 100 out of 5061 paid Medicare claims to the red-flagged cardiologist — about 2 percent. For each claim, auditors checked to: 1) make sure the patient was enrolled in the Medicare program; 2) ensure documentation said service was actually provided, and 3) determined whether service was claimed at correct rate. The auditors did not look at medical necessity.

Adapted from Part B Insider. Download your 2 FREE sample issues here.

Are you on your self-auditing game and ready for when the OIG comes knocking? Learn about how to prepare for the OIG’s 2010 Work Plan in this AUDIO TRAINING EVENT.