Part B Insider (Multispecialty) Coding Alert

Published on Fri Apr 16, 2004 PDF

If you are receiving extra contractual charges from Medicare patients outside of the usual co-pay or deductible, use caution.
 
The HHS Office of Inspector General issued an alert March 31 warning physicians that if there are covered items or services included in your non-Medicare patient-care packages, you could be looking down the barrel of an assignment violation - and exclusion from Medicare.
 
The alert cites recent allegations against a physician who the OIG says presented his patients with a health care contract that offered benefits such as "coordination of care with other providers" and "extra time" spent on patient care. Some of these services, the OIG argues, were already reimbursable under Medicare.
 
To resolve the charges, the doctor paid a settlement to the OIG.
 
"If participating physicians decide they want to charge patients additional fees they should be mindful that they are subject to civil money penalties if they request any payment for already covered services from Medicare patients," says Acting Principal Deputy IG Dana Corrigan.