Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Review New Smart Form Guidance from Cahaba

Published on Fri May 26, 2017

PDF

Plus: A Chicago physician is looking at possibly 120 years for Medicare fraud.

If the bar code is incorrect on your appeals form, Cahaba will reject it.

Medicare Administrative Carrier Cahaba GBA recently offered guidance on its website concerning a rise in the number of improperly filed appeals smart forms. Many Part B providers are “downloading or copying” the form “to submit their appeal request,” the MAC says. But the bar codes on the download are different from the bar codes that are generated during the submission process, which confuses the system.

“Please note, when smart forms are downloaded or copied, the bar code does not change on the form, and as a result, the incorrect patient/claim information is submitted,” Cahaba advises. “Please access the form from Cahaba’s website each time an appeal needs to be submitted. Providers should complete the form online, print it, sign the form and fax/mail to Cahaba.”

The MAC suggests that to avoid future issues that providers are encouraged to access and submit appeals requests through its InSite portal. “InSite saves time and reduces human error by eliminating the need for the request to be scanned, transmitted to the Appeals department and then indexed,” the guidances notes.

Resource: To log into Cahaba Part B’s InSite portal, visit >https://insite.cahabagba.com/insite/start.swe?SWECmd=Login&SWECM=S&SWEHo=insite.cahabagba.com.

In other news …

The old adage goes: If it’s not broken, don’t fix it. The same could be said about medical necessity, meaning: If it’s not necessary, don’t do it.

Chicago dermatologist, Omeed Memar, submitted falseclaims for “actinic keratosis, a precancerous condition that he knew many of his patients did not actually have,” a Department of Justice release from May 11, 2017 said. The physician lied about the symptoms and need for treatment from 2007 to 2013, never showing the medical necessity for the patients’ “fictitious diagnosis.”

The sentencing is set for Sept. 28, 2017 and could hold up to a 120-year prison term.

Take a look at the DOJ release at: https://www.justice.gov/usao-ndil/pr/chicago-dermatologist-convicted-federal-fraud-charges-billing-health-insurance-programs.