Medicare Compliance & Reimbursement

Follow these strategies to ensure you stay on the right side of the law.

1. Check in on Your Billing Practice. Even if you've hired the most competent billing company in the world, your physicians are ultimately responsible for the codes they report to Medicare. Therefore, it's important for your practice to request reports from the billing company so you can check on your collection rates, E/M code distribution, and denials.

2. Ensure That Your EHRs Are Secure. A new electronic health record may have been a godsend to your practice's efficiency, but it can also create opportunities for HIPAA privacy breaches, experts say. In the past, OIG auditors have been known to sit in the parking lots of healthcare facilities with laptop computers to get onto the facility's wireless network, said Julie Taitsman, MD, the OIG's chief medical officer, during a 2011 HEAT Provider Compliance Training session. They then determine whether they can access patient information that's supposed to be private.

3. Follow Your Compliance Plan. Many practices write a compliance plan, file it away, and assume it will keep the auditors away. But it's also essential that you integrate that compliance plan and ensure that the entire staff remains compliant in all aspects of the healthcare regulations. The only effective compliance plan is the one that's being followed, experts advise.

4. Make Sure All Physician Orders Are in Writing. Any order for a physician-requested service, such as an x-ray or a laboratory test, must be documented by the physician (or non-physician practitioner) who ordered it. Without the physician's order, you can't bill the claim.

5. Think of Miscoding Place of Service As Potential Upcode. If you perform a service in the hospital and you assign an outpatient place of service code to the claim, you'll collect more than you deserve. That's because Medicare pays more for services you perform in your practice vs. the hospital to account for the cost of doing business at your office.