Medicare Compliance & Reimbursement

Tacking an E/M code onto your eye injections as a standard billing strategy? Not so fast. The OIG is looking at these transactions and does not like what it sees.

The new OIG report, released last week, indicates that for 85 services out of 100 that the OIG sampled, a particular hospital incorrectly billed E/M services during outpatient eye injections, creating overpayments of $8,100. When extrapolated to all of that hospital's eye injection claims, the hospital collected $211,000 more than it should have over a two-year period.

In most cases, the OIG simply found that the physicians didn't perform E/M services that were significant and separately identifiable from the injections. Instead, the OIG determined that any evaluation performed was "part of the usual preoperative work of the eye injection procedure," the report noted.

To read the complete report, visit http://oig.hhs.gov/oas/reports/region1/11100515.pdf.

Don't Pay Docs For Home Health Face-To-Face Documentation

Physicians must turn to Medicare for payment, a recent Q&A says. If you cave in to physicians' demands for payment for documentation required by Medicare, you could be courting fraud and abuse charges.

Docs are not permitted to charge home health agencies an "administrative fee," such as $25, to complete the patient's face-to-face documentation, Home Health & Hospice Medicare Administrative Contractor Palmetto GBA says in a question-and-answer set posted from its April 10 Ask the Contractor Teleconference (ACT).

Law requires that "the certifying physician must document that he or she or an allowed nonphysician practitioner (NPP) had a face-to-face encounter with the patient in order to establish an effective home health treatment plan, i.e. physician's orders, for the patient's current condition," Palmetto explains. "There is no separate Medicare payment for this service."

"The physician would need to look to Medicare Part B for payment consideration for services provided during the visit encounter," Palmetto adds on its website.

Texas Healthcare Marketer Pleads Guilty To Kickbacks

Once again, the feds aren't just targeting home care providers when busting Medicare fraud. A McAllen, Texas health care marketer has pled guilty to taking kickbacks in return for referring patients to a variety of providers including home health agencies, according to a release from the Department of Justice.

An indictment unsealed in January accused Alicia Vasquez of taking at least $70,000 in kickbacks to refer patients from her "health care resource center," David's Star Loving Vision, to home care providers, durable medical equipment suppliers, and physicians. Vasquez and the entities receiving her referrals concealed the payments by routing them through third parties, among other ways, the DOJ says.