Medicare Compliance & Reimbursement

Industry Notes:

OIG Audit Finds Only 15 Percent of E/Ms With Eye Injections Were Properly Billed

Tacking an E/M code onto your eye injections as a standard billing strategy? Not so fast. The OIG is looking at these transactions and does not like what it sees.The new OIG report, released last week, indicates that for 85 services out of 100 that the OIG sampled, a particular hospital incorrectly billed E/M services during outpatient eye injections, creating overpayments of $8,100. When extrapolated to all of that hospital's eye injection claims, the hospital collected $211,000 more than it should have over a two-year period.In most cases, the OIG simply found that the physicians didn't perform E/M services that were significant and separately identifiable from the injections. Instead, the OIG determined that any evaluation performed was "part of the usual preoperative work of the eye injection procedure," the report noted.To read the complete report, visit http://oig.hhs.gov/oas/reports/region1/11100515.pdf. Don't Pay Docs For Home Health Face-To-Face DocumentationPhysicians must turn to Medicare [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.