Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Oklahoma Slashing Medicaid Pay

Published on Mon Apr 04, 2016

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Plus: Physician under fire for outsourcing surgical monitoring services.

Providers in Oklahoma are about to see a significant pay cut for their Medicaid claims, and there isn’t much time to prepare. Starting July 1, you’ll see a startling 25 percent decrease in the state’s Medicaid payments, the Oklahoma Health Care Authority (OHCA) announced on March 29.

After slashing the reimbursement by 25 percent, Oklahoma’s Medicaid rates will stand at about 65 percent of the national Medicare rate—and it’s possible that more cuts will come, impacting over 46,000 providers, the OHCA said in a March 29 statement.

“I do not take these cuts lightly,” said OHCA CEO Nico Gomez in the statement. “As the state’s largest health insurer, the Oklahoma Health Care Authority underpins the entire fabric of the state’s health care system that serves all Oklahomans. I worry about the infrastructure of our health care system in light of these cuts. From a business standpoint, I’m afraid many providers will close their doors to our patients. In some cases, especially in rural parts of our state, health care professionals will have to move their business to larger communities in order to survive financially,” Gomez added.

Resource: To read more about Oklahoma’s Medicaid cuts, visit www.okhca.org/about.aspx?id=18904.

In other news…

A Georgia physician is in hot water with the feds after agreeing to perform intraoperative monitoring to check patients’ nerve and spinal cord activity during surgery—and then passing the responsibility off to a medical assistant.

The doctor pleaded guilty to health care fraud on March 25 after the government discovered that he had collected over $1.1 million for the services, despite not having personally performed them. In one instance, the Department of Justice said in a statement, the doctor billed for monitoring services even though he was on an international flight when the monitoring took place.

The physician was discovered after Medicare auditors noticed irregular billing patterns compared to the data of other surgeons. In addition, the doctor had faced complaints via the OIG hotline. He faces sentencing in June.

Resource: To read more about the case, visit www.justice.gov/usao-ndga/pr/georgia-doctor-pleads-guilty-false-billing-surgical-monitoring-performed-medical.