Medicare Compliance & Reimbursement

Consider using this individualized method for doing retrospective reviews. Audit not and your claims will be fair game for government entities and whistleblowers trolling for Medicare overpayments. You can, however, cast an effective compliance net with these expert tips for policing your own claims and managing scenarios where you may have billed Medicare improperly. 1. Bulletproof your operations with prepayment reviews. That's the tack that cardiology consultant Jim Collins, CCC, CPC, recommends his clients take. To perform a prospective audit, you place "charges on hold for the audit sample," conduct the audit and correct any inappropriately coded services before submitting the claims, advises Collins, president of CardiologyCoder.com Inc. Using a prepay approach for all claims can improve your compliance track record to the point that you may be safe just reviewing a sample to detect problems. For example, many skilled nursing facilities routinely do what's known as the "triple check" [...]