Confused whether to code a patient as new or established? Uncertain how to bill chemotherapy infusions for the same patient on the same day? You’re not alone. These are just two of the most common physician billing errors reported by Medicare contractors. To help providers understand these types of claims submission problems and avoid certain billing errors, the Centers for Medicare & Medicaid Services (CMS) has published its second issue of the free Medicare Quarterly Provider Compliance Newsletter.
The general format of the newsletter describes each problem identified by Medicare claims processing contractors, recovery audit contractors (RACs), program safeguard contractors, zone program integrity contractors (ZPICs), and other governmental organizations, such as the Office of Inspector General (OIG). It then explains the issues that may occur as a result of the error, the steps CMS has taken to make providers aware of the problem, and guidance on what providers need to do to avoid repeating the error or improper activity. The newsletter also refers providers to other documents for more detailed information.
In this newsletter (February 2011, Vol. 1, Issue 2), you will learn of recovery audit findings that affect Medicare fee-for-service providers, including inpatient hospitals, physicians, and durable medical equipment (DME) suppliers.
Specifically, the top recovery audit findings in this issue are:
For inpatient hospitals:
- Tracheostomy — incorrect coding
- Excisional debridement — incorrect coding
- Not a new patient — incorrect coding
- Evaluation and management (E/M) billing during the global surgery period
For physicians and outpatient hospitals:
- Chemotherapy administration and non-chemotherapy injections and infusions — incorrect coding
For DME suppliers:
- DME while patient is receiving care from a hospice provider
- Budesonide — dose vs. billed units
Read the newsletter for an explanation of these common coding and billing errors and to gain advice on how to prevent them.
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