OIG: Physicians Generally Miscode POS

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  • August 3, 2009
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A recent Office of Inspector General Investigation (OIG) audit finds physicians generally code the place of service (POS) incorrectly on claims they submit to Medicare Part B carriers.

According to the OIG report, physicians incorrectly coded 129 of 150 sampled services by using office POS  11 for services performed in outpatient hospital departments (HOPDs) (POS 22) or ambulatory surgical centers (ASCs) (POS 24).

Although this small sampling of incorrectly coded service claims amounts to only $6,797 in overpayments, the OIG estimates that carriers nationwide overpaid physicians $20.2 million for incorrectly coded services provided over a two-year period ending Dec. 31, 2006.

The Centers for Medicare & Medicaid Services (CMS) agreed with OIG’s recommendations to recover all overpayments of this nature, strengthen physician education processes and internal controls to prevent future incorrect POS coding, and develop a data match to identify physician services at high risk for POS miscoding.

CMS said they will conduct a pilot to determine whether recovery of the overpayments identified in the report is cost effective and relay the pilot’s results to recovery audit contractors (RACs) for a possible review of claims on or after Oct. 1, 2007. CMS will also supply RACs with high-risk codes so they can develop system edits to target these services.

Download the complete report, posted July 10 on the OIG Web site.

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