Medicare Compliance & Reimbursement

OIG Continues to Target Physicians

The percentage of medical practices that were found or pled guilty to Medicare fraud charges is still fairly high, a new report indicates.

In an analysis of Department of Justice and OIG data from 2010, the Government Accountability Office found that 43 medical practices were found or pled guilty or no contest to healthcare fraud, while another 130 medical centers/clinics fell into that category. Combined, these medical facilities make up 18.7 percent of the total number of subjects found or pled guilty or no contest -- which is the highest percentage among all provider types.

Coming in a close second were the 171 durable medical equipment suppliers that were found or pled guilty, the GAO says. This category made up 18.5 percent of total guilty subjects.

The report is online at www.gao.gov/assets/660/650341.pdf.

CMS Stresses ‘Importance of Legible Medical Records’

You may shake your head when you hear that some physicians maintain incomplete notes, and that auditors ask those practitioners for money back since their documentation didn’t support the codes they billed. But have you ever thought that writing illegibly could make you qualify for CMS’s interpretation of incomplete notes?

"When determining the medical necessity of an item or service billed, Medicare’s review contractors must rely on the medical documentation submitted by the provider in support of a given claim," CMS says in MLN Matters article SE1237. "Therefore, legibility of clinical notes and other supporting documentation is critical to avoid Medicare FFS claim payment denials."

Despite the old stereotype of physicians’ handwriting being impossible to read, your practitioners should ensure that their documentation is legible -- not only by staff members familiar with it -- but also by anyone who might be reading the notes.

To read the MLN Matters article, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1237.pdf.

Feds Recovered $6.9 Billion In FY 2012

Medicare may be cutting back on payments for some of your services, but the OIG has found additional ways to save money by recouping billions from medical practices nationwide. According to the OIG’s 2012 Semiannual Report, which covers the six month period from April through Sept. 30, 2012, the government recovered about $6.9 billion in Fiscal Year 2012.

That figure includes $923.8 million in audit receivables and $6 billion in investigative receivables. Plus, the agency identified another $8.5 billion in savings resulting from legislative, regulatory, or administrative actions that were supported by the OIG’s recommendations, the Report indicates.

For instance, the OIG identified a coding trend in which E/M service levels rose significantly. Between 2001 and 2010, payments for E/M services increased by 48 percent vs. 43 percent for Part B goods and services in general. As a result, the OIG advised Medicare contractors to review physicians’ billing for E/M services, educate physicians on proper billing for these services, and to review physicians who bill higher-level E/M services.

To read the OIG’s Semiannual Report, visit oig.hhs.gov/reports-and-publications/archives/semiannual/2012/fall/sar-f12-fulltext.pdf.