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Don’t Get Burned by a Government Audit

Speaker: Nikki Taylor, MBA, CPC®, COC™, CPMA®, CRC™,


AAPC Fellow

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Learning
Objectives

• Get the inside scoop on top billing errors


• Learn the ins and outs of CMS’ new TPE program
• Get to know what’s new at OIG
• Gain practical advice on how to discuss government compliance with
your providers
• Highlight helpful tools and resources

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Top Billing Errors, cont.

1. Invalid procedure and diagnosis codes


2. Multiple E/M services billed within same group
3. Billing services without qualifying service or
procedure

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Top Billing Errors, cont.

Invalid Procedure and Diagnosis Codes


• Pay attention to annual code revisions
• ICD-10-CM codes go into effect on Oct.
1
• CPT®codes go into effect on Jan. 1
• Review new, deleted, and revised
codes,
• Ensure your systems are updated

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Top Billing Errors, cont.

Multiple E/M services billed within same group


• Physicians in the same group practice and of the same specialty
• MUST bill and be paid as a single physician
• Visit documentation must be billed as a combined visit for reporting purposes
• Example 1: Patient sees two providers on the same DOS
• Example 2: Patient sees one physician for a procedure and then sees
another physician w/in the same practice w/in 3 years

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Top Billing Errors, cont.

Billing services without qualifying service or


procedure
• Remember the rules for add-on codes
• Not payable without qualifying service or procedure
• Example: CPT® code 44203
• Bill first CPT® code 44202

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CERT Top Billing Errors

• CMS Quarterly Provider Compliance Newsletters


2017
• Updated Quarterly
• January
• April
• July
• October
• Top compliance issues found by CMS

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CERT Top Billing Errors, cont.

Retinal Photocoagulation
• CPT® Code 67228
• CERT conducted a special study of retinal photocoagulation
procedures
• Billed with 67228
• Submitted from July through September 2015

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Resource
s

• https://www.cms.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNProducts/MLN-Publications.html
• https://www.cms.gov/Research-Statistics-Data-and-
Systems/Monitoring-Programs/Medicare-FFS-Compliance-
Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html
• https://oig.hhs.gov/compliance/compliance-resource-portal/
• https://oig.hhs.gov/oas/reports/region9/91602026.pdf
• https://oig.hhs.gov/reports-and-publications/workplan/index.as
p
55
tears/
• https://www.novitas-solutions.com
Click Below to Read Download Full PPT

https://www.supercoder.com/medical-codi
ng-webinars/dont-get-burned-by-a-govern
ment-audit

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