Part B Insider (Multispecialty) Coding Alert
'Mobile' Physician Service Charged With Fraud
PDF
Plus: CMS refers ICD-10 date-span questions to local MACs.
Making house calls isn’t known as being especially lucrative—unless the physician in question pumps up his or her charges exponentially higher than a legitimate service would pay. Such is the case in question that was part of a $2.568 million alleged fraud ring that involved several Midwestern physicians and their mobile physician services.
The service was known for making house calls in six states, but the doctors who performed the in-home patient visits allegedly charged for services that were significantly more complicated and time-consuming than what they actually performed. In addition, some patients were not actually confined to their homes, allowing home healthcare agencies to bill for additional services even though these patients were not legally qualified to receive the care.
The house-calling doctors apparently billed 99 percent of all established-patient visits using the two highest codes (99214 and 99215). One former employee of the mobile doctors told federal investigators that the doctor said 99214 was “the default code” for patient visits to support the gasoline and time spent seeing the patient.
The physicians involved face between five and ten years in prison if convicted. To read the entire news release about the arrests, visit www.justice.gov/usao/iln/pr/chicago/2013/pr0827_01.html.
Part B Insider (Multispecialty) Coding Alert
- Part B Payment:
2 Historically Bad CCI Edits Will Soon Be History, CMS Says
Plus: Recoupments over incarcerated patients flummoxes practices nationwide. If ophthalmological evaluations are a big part [...] - ICD-10:
Conversion to ICD-10 Won't Be A Huge Financial Burden, CMS Reps Say
Plus: ICD-10 claims will allow you to submit the letters as either upper or lowercase, [...] - Part B Revenue Booster:
Failure to Differentiate Co-Surgery From Assistant Surgery Could Cost You Thousands
Hint: Separate op notes can help you tell the difference. Our physician performs a procedure [...] - Part B Coding Coach:
Brush Up on Foot Anatomy to Step Toward Coding Success
Tip: Keep modifiers LT, RT, TA-T9 handy to specify work on different areas of feet [...] - Physician Notes:
'Mobile' Physician Service Charged With Fraud
Plus: CMS refers ICD-10 date-span questions to local MACs. Making house calls isn’t known as [...] - In other news
The current number one question on CMS’s “Frequently-Asked Questions” website isabout ICD-10, not surprisingly. The [...] - Reader Question:
Know How to Email Without Violating HIPAA
Question: I sometimes e-mail patient records to consultants for help on how to bill. How [...] - Reader Question:
Use Caution When Separating CCI Edits
Question: During a breast biopsy, the surgeon also performed a scar revision involving multi-layered closure [...]