Medicare Compliance & Reimbursement
Florida Fraudsters Steal Identity of Legitimate Therapist to Bilk Medicare Out of Thousands
Practitioners may be keeping an eye on their patients' data to ensure that no one steals beneficiaries' identities -- but it's also smart to keep your providers' identities secure. One physical therapist learned that the hard way after two Florida residents pleaded guilty last week in a scheme to defraud Medicare. The fraudsters bought a therapy practice and indicated that they planned to provide physical therapy to Medicare patients. However, they stole the identity of a legitimate PT to submit claims to Medicare. In addition, they stole Medicare data from people that they knew so they could send claims to Medicare on those patients' behalf, to the tune of $757,654, a June 10 Department of Justice press release notes. After pleading guilty, the fraudsters each face up to 10 years in prison and a $250,000 fine. To read the complete press release, visit www.justice.gov/opa/pr/2011/June/11-crm-763.html. Tip: Treat your physician data, including birth dates, NPIs, and Social Security Numbers, with the same security settings that you use for your patient data. Use password-protected computers for all Medicare claims related activity, and file all paper documents in a secure area. Plus, you should shred papers that include this information on them before throwing them in the trash. Button Up Those E/M Claims, CMS Tells Providers Assigning E/M levels willy-nilly? You might be one of the providers that CMS found who erroneously assigned the wrong E/M code to their claims, causing billions in inappropriate Medicare payments. According to a new MLN Matters fact sheet, Medicare providers billed about $28 billion in E/M services between April 2009 and May 2010, but CMS found that "8.4 percent of those E/M payments were identified as being billed at the wrong code level -- either too high or too low," the document states. To end providers' confusion about E/M billing, CMS offers several helpful tips on assigning the appropriate E/M level in its new fact sheet, which you can access at www.cms.gov/MLNProducts/downloads/Evaluation_Management_Fact_Sheet_ICN905363.pdf. Deadline For PECOS Edits Still Up In The Air You can put PECOS edits a little further down on your crowded priority list. CMS "has not yet determined when it will begin to apply the expanded edit for ordering/ referring provider claims," the agency says in an e-mail message to providers. Background: These edits are applicable to ordering/referring providers that do not have a record in the Provider Enrollment, Chain, and Ownership System (PECOS). Currently, providers receive informational edits about ordering/referring physicians not in PECOS. In the edits' next phase, claims will reject due to the problem. Stay tuned: "CMS will give providers ample notice before the ordering/referring provider claim edit is applied," the agency pledges.
Medicare Compliance & Reimbursement
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Florida Fraudsters Steal Identity of Legitimate Therapist to Bilk Medicare Out of Thousands
Practitioners may be keeping an eye on their patients' data to ensure that no one [...]
