Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 27, 2009 PDF

Plus: E-prescribing might be making your head spin, but CMS finally offers a sample e-script claim that could guide your way.

If you thought the OIG wasnt looking at your claims from all possible angles, its time to think again.

A new OIG report, issued on April 22, notes that although only two percent of Medicare beneficiaries live in South Florida, this area accounted for 17 percent of Medicares total spending for inhalation drugs in 2007.

Making the billing trend even more suspicious, the OIG found that the beneficiary listed on 62 percent of the S. Florida inhalation drug claims had not had a Medicare-billed office visit or other service over the previous three-year period with the physician who prescribed the medication.

As a result of the OIG investigation, CMS was advised to ensure that its contractors enforce the coverage guidelines for inhalation drugs, eliminate Medicares vulnerability to potentially fraudulent or excessive inhalation drug claims in South Florida, and review cases where the DME supplier appears to be fraudulently billing Medicare for inhalation drugs.

To read the complete OIG report, visit www.oig.hhs.gov/oei/reports/oei-03-08-00290.pdf.