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Post-op visits being billed prior to Surgical Charges

dollybrandie

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Looking for insite into this situation. Patient has surgery and for some reason the OR documentation is delayed by the performing surgeon and no surgical charges are billed for several weeks. In the mean time, the surgeron sees the patient on follow-up and bills a E&M level of service. The bill is processed through the system and is not "caught for global issues" due to the lack of surgical charges in the system. Normally our billing system would catch the E&M and that charge would be changed to "no bill". In this scenerio it gets paid by, let's say, Medicare prior to them receiving the surgical claim.
My question is this, has this scenerio happen to others and what was the outcome. We are attempting to be pro-active.
 

GaPeach77

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Looking for insite into this situation. Patient has surgery and for some reason the OR documentation is delayed by the performing surgeon and no surgical charges are billed for several weeks. In the mean time, the surgeron sees the patient on follow-up and bills a E&M level of service. The bill is processed through the system and is not "caught for global issues" due to the lack of surgical charges in the system. Normally our billing system would catch the E&M and that charge would be changed to "no bill". In this scenerio it gets paid by, let's say, Medicare prior to them receiving the surgical claim.
My question is this, has this scenerio happen to others and what was the outcome. We are attempting to be pro-active.

Speaking from the perspective of auditing for a CMS contracting company, Medicare is most likely aware and you can expect a request for a takeback one of these days. It is this type of billing that Medicare red flags and watches. Expect that request because your surgeon is not the only one who has billed in this way. Certain providers are red flag and watched for months before the request for a take back is mailed. The bigger the request for a takeback, the better the investigators at CMS look. I am sure they are already aware.:rolleyes:
 
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