Medicare Compliance & Reimbursement

Location is everything when it comes to Medicare claims.

Payors are under increasing pressure to weed out claims with incorrect place of service codes - and take money back from the physicians who billed them.

In an audit issued Oct. 22, the HHS Office of Inspector General estimated that Wisconsin Physicians Service Insurance Corporation had made $742,510 in Medicare Part B overpayments to physicians for incorrectly coded services. According to the report, 79 of 100 sampled physician services were actually performed in a facility, such as an outpatient hospital department or a freestanding ambulatory surgical center, but were inappropriately billed by a physician with the incorrect "office" place of service code, which is reimbursed by Medicare at a higher amount.

The problem: Weaknesses at both the payor and the physician office level. The OIG says doctors need to be better educated about the importance of correctly reporting place of service codes. It also wants the payor to do more to prevent, identify and recover such overpayments.

To read the report, "Review of Place of Service Coding For Physician Services - Wisconsin Physicians Service Insurance Corporation, Madison, Wisconsin" (A-05-04-00025) go to www.oig.hhs.gov/oas/reports/region5/50400025.pdf.

Lesson Learned: Providers need to be sure the correct place of service is identified on claim forms submitted to Medicare Part B carriers.