Medicare Compliance & Reimbursement
Part B Payments 'Vulnerable To Fraud,' Watchdog Says
Nursing homes could be hotbeds of inappropriate billings, warns one government agency.
Physicians' Part B claims for services to patients who are in a nursing home but not during a Part A-covered stay are "particularly vulnerable to fraud and abuse," warns the HHS Office of Inspector General (OIG) in a new report (OEI-05-06-00240). Congress has asked the OIG to keep an eye on doctors billing for services that the nursing home may already be billing for separately.
The OIG's new report ("Medicare Part B Services For Nursing Home Residents") doesn't draw any conclusions. But it does point to a lot of money going to doctors billing in nursing homes, and that may indicate duplicate billings. Medicare paid $5.3 billion for Part B services for non-Part A nursing home patients.
Ten services accounted for 79 percent of these billings. These included "minor procedure," "nursing home visit," "lab test," "specialist" and "standard imaging." The OIG says it will be looking at these areas and gathering more up-to-date information to figure out how many payments overlapped with services the nursing home billed.
Medicare Compliance & Reimbursement
- SPENDING:
Presidential Budget To Cut $100 Billion From Medicare, Medicaid
Democratic presidential hopefuls lambast 2008 budget.
President Bush released his budget for the fiscal year 2008 [...] - CARDIOLOGY:
Avoid Waiting Until Patients Develop Symptoms To Look Into Stenting
Start identifying asymptomatic patients with advanced stenosis.
Cardiologists could soon be providing carotid artery stenting to [...] - DIAGNOSIS CODING:
Take Advantage Of Larger Space For Diagnosis Codes In July
Urge your carrier to expand 1500 form to recognize multiple diagnoses.
Complex patients require more than [...] - MEDICARE PART B:
Mistake--Listing Preop 'V' Codes As Primary Without Including Secondary Diagnosis
Don't let 'unacceptable' list scare you away from 'V' codes.
Myth: You can never use "V" [...] - CODING:
Don't Use 93508 For 'Roadmap To Stent Placement'
Be prepared to fight for reimbursement for 93508 with 92980.
Is your cardiologist receiving proper reimbursement [...] - HIPAA:
Learn How OHCAs Can Slay The NPP Beast
Untangle the intricacies of OHCAs and NPPs.
Knowing how to address the Health Insurance Portability and [...] - COMPLIANCE:
Part B Payments 'Vulnerable To Fraud,' Watchdog Says
OIG is watching doctors' nursing home visits.
Nursing homes could be hotbeds of inappropriate billings, warns [...] - INDUSTRY NOTES:
E-Prescribing Gets New Push From National Initiative
Plus: What health plans, providers can do to reduce Medicare costs.
Insurers have long touted e-prescribing [...]
