In Audit
Apr 7th, 2017
The main reason Medicare denies claims is because there is insufficient documentation in the medical record. For all surgical services, make sure the medical record has these four elements: Correct date of service Reason for procedure Signed operative report Physician signature and/or signature log or attestation for an illegible signature Showing medical necessity is only ...
In Audit
Jan 19th, 2017
In the 2017 Work Plan, the Office of Inspector General (OIG) is reviewing Medicare’s billing and reimbursement integrity for two diagnosis-related groups (DRGs): inpatient claims for kwashiorkor diagnosis and mechanical ventilation. Kwashiorkor is a severe protein malnutrition that usually “affects children living in tropical and subtropical parts of the world during periods of famine or ...
In Audit
Jan 10th, 2017
If you haven’t stumbled on the treasure trove of information in the Office of Inspector General’s (OIG) Media section of their website, it’s time you found it. OIG now keeps you informed on fraud, enforcement, and compliance via podcast. The podcasts are found on the OIG website with Mike Kane, Office of External Affairs, discussing the monthly ...
In Audit
Jan 3rd, 2017
The use of medical scribes has become more common in recent years, as practices and facilities search for ways to alleviate documentation tasks for providers, thereby improving their overall productivity, Medical scribes are not medical providers (although often scribes may have some medical background), and he or she is never meant to treat a patient. ...
In Audit
Dec 16th, 2016
In inpatient auditing, you are auditing ICD-10-CM diagnosis codes, ICD-10-PCS procedures codes, and much more. The purpose of inpatient auditing is to ensure that the correct DRG was assigned. All of the following factors play a role in making sure the correct inpatient reimbursement is received: 1. Assignment of the principal diagnosis – If you ...