Part B Insider (Multispecialty) Coding Alert

Published on Sat Sep 19, 2009 PDF

This New York cardiologist spent time under the OIG's microscope, only to learn he was billing properly.

Turns out the old saying is true: If you haven't done anything wrong, an OIG audit is nothing to worry about.

A New York cardiologist who collected over $1.3 million over a three-year period for 5,061 claims caught the OIG's eye due to a "high volume of Medicare claims in comparison to other cardiologists throughout New York state," according to the OIG's report on the topic, which was released on Oct. 14.

The OIG reviewed the cardiologist's records for the three-year period, but found that the physician, who specialized in non-invasive procedures, complied with Medicare reimbursement requirements. Therefore, the OIG made no recommendations and did not request any fund recovery from the physician.

To read the complete OIG report, visit http://www.oig.hhs.gov/oas/reports/region2/20901003.pdf.

In other news ...

Good news: It may hang on for another two years.

In mid-September, Sen. Max Baucus (D-Mont.) released a summary of legislation that includes a two-year extension of the therapy cap exceptions process, according to PT Bulletin Online.

The proposal also includes a one-year fix for the Medicare Physician Fee Schedule's (MPFS) sustainable growth rate (a 0.5 percent increase, as opposed to the 21.5 percent decrease included in the MPFS final rule). In addition, the proposal would extend the 1.00 floor for geographic practice cost indices for two more years.

Also of note, the Senate bill bans specialty hospital self-referral and requires "increased transparency on disclosure of financial relationship between physicians and referred professional services," the Bulletin noted.