Medicare Compliance & Reimbursement

Plus: Michigan podiatrist gets tripped up with false claims conviction.

The 2018-2019 flu season began on Aug. 1. CMS wants to help providers and their staffs make sure related claims aren’t denied.

Remember, flu shots are paid by season and not by the year, reminds CMS guidance. And due to that, it is possible for a beneficiary to receive more than one immunization in a single calendar year.

CMS released its influenza vaccine payment guidelines last month, which include details on how much Medicare Part B will pay for each CPT^® and HCPCS code.

Reminder: Medicare Part B beneficiaries have no out-of-pocket costs for flu vaccines as no deductibles or copayments apply.

Resources: For more information on code changes, Medicare Part B payment, and institutional billing, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10914.pdf and www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10871.pdf.

In other news…

If you submit claims for the “Unna boot,” make sure the medicated dressing is medically necessary and actually utilized, a recent case shows.

Detroit podiatrist, Lawrence Young, DPM, was sentenced to more than two years in prison and $337,907 and change for false and fraudulent claims, specifically related to the Unna boot. “Young admitted regularly submitting these claims for reimbursement even though he knew that his patients routinely received nothing more than a non-medicated dressing,” noted a Department of Justice release on the settlement. “The scheme involved the submission of more $1 million in fraudulent claims to Medicare.”

See the details of the case at www.justice.gov/opa/pr/detroit-area-podiatrist-sentenced-prison-health-care-fraud.