Part B Insider (Multispecialty) Coding Alert

Published on Tue Jun 03, 2014 PDF

Even as Medicare slashes payments for some services, the government still has additional ways to bring in cash by recouping billions from medical practices nationwide. According to the OIG’s Semiannual Report to Congress Oct. 1, 2013 to March 31, 2014, the agency reported expected recoveries of over $3.1 billion through audit receivables, investigations, and other actions.

The report outlines common enforcements, such as those on pill mills, as well as additional crackdowns. “Our reports continue to identify vulnerabilities in, and recommendations for improving, the Centers for Medicare & Medicaid Services’ (CMS) oversight of the contractors that administer more than a half trillion dollars in benefits each year,” said Inspector General Daniel R. Levinson in the document. 

“Reports generated during this reporting cycle identified Medicare Administrative Contractor performance shortcomings and highlighted issues that limit CMS’s ability to effectively oversee Part C and Part D contractors,” Levinson continued. “Many CMS contractors rely on medical records to conduct work aimed at ensuring program integrity, yet a new OIG report raises concerns about contractors’ ability to identify improper payments and fraud using electronic medical records. Our reports offer recommendations to improve contractor performance and CMS oversight.”

To read the complete 99-page report, visit http://oig.hhs.gov/reports-and-publications/archives/semiannual/2014/SAR-S14-Web-Final.pdf.