Medicare Compliance & Reimbursement

Tip: Don’t share your NPI with others.

Though the Centers for Medicare & Medicaid Services (CMS) appear to be in the midst of an administrative burden-cutting renaissance, denials and enforcement continue to rise. That’s why it’s critical to do all you can to avoid behaviors that put your practice at risk of committing Medicare fraud and abuse.

Last month, Part B Medicare Administrative Contractor (MAC) NGS Medicare offered a plethora of advice and tips on how to circumvent fraudulent practices at your office in the webinar, “Medicare Fraud and Abuse.”

Here are 10 tips that NGS consultant Lori Langevin advises providers to consider as they try to remain compliant:

1.  Safeguard your NPI. “You never want to let anyone bill under your NPI,” Langevin warns. Make sure you let your MAC know if you relocate or retire, too, so that your MAC can deactivate your NPI, she reminds.

2.  Pick out your own procedure codes. As a practitioner, you’re liable for whatever is submitted under your NPI. “If you delegate this responsibility to someone else, you want to make sure that you make periodic checks to ensure accuracy,” she advises.

3.  Record the services you provide. Clean, concise, and signed documentation helps your practice prove you rendered services — and that you deserve payment for reasons A, B, and C. “If the service is not documented, as far as we’re concerned, it was not done,” says Langevin.

4.  Take medical necessity certification seriously. You shouldn’t sign a certification of medical necessity unless it’s truly necessary. For example, “you should never certify supplies for patients that you’ve never seen or examined,” she counsels.

5.  Cut down on employee risks. It’s important to utilize policies that encourage compliance and minimize risks. “You want to make sure you develop procedures that safeguard your practice and carefully delegate who you are giving signing authority to,” Langevin says.

6.  Be cautious and savvy in your business relations. Deep discounts, free services, or incentives for referrals or supplies should give you pause. “Never allow yourself to be coerced into any fiscal or financial arrangement,” she cautions.

7.  Keep on top of your billing services. This might entail setting guidelines with your billing services to follow your notes and use your codes. And remember, never bill Medicare for something you didn’t perform or have documentation for.

8.  Pay attention to Medicare updates and news. From listservs to webinars to open door forums — keep up with your MAC and any changes that impact your practice compliance and payments.

9.  Talk to your patients. When you know your patients, it’s harder for fraudsters to hijack your practice by usurping beneficiaries’ Medicare numbers and information. Photocopy patients’ Medicare cards, update addresses and phone numbers, “and be aware of those that want to fabricate cards and numbers” because “as the provider you are responsible for verifying” the information is correct, urges Langevin.

10.  Answer when Medicare calls. When your MAC asks for medical records or documentation, there’s usually a good reason. “Don’t ignore requests for information,” she says.