Medicare Compliance & Reimbursement

Between conversion factor issues and sequestration, Medicare is cutting back on payments for some services, but the HHS Office of the Inspector General (OIG) is finding additional ways to save money by recouping billions from medical practices across the country. According to the OIG’s April 2013 to Sept. 2013 Semiannual Report to Congress, the agency recouped $5.8 billion through recommendations, investigative efforts, and audit recovery during that six month period.

The report, released on Dec. 23, outlines some of the targets that were the most troublesome for OIG reviewers over the past year, as well as some they are looking to focus on in the coming months.

For example, the OIG noted that MACs often ignored “G” modifiers such as GY and GX, and ended up paying for services that should have been denied. “Although contractors have checks that affect some of these claims, such as determining whether the services and items met Medicare frequency limitations, they do not specifically check for claims for which providers expect not to be paid.”

As a result Medicare paid almost $744 million to Part B providers for claims that included the G modifiers, the report notes.

To read the OIG’s Semiannual Report, visit the agency’s website at oig.hhs.gov/reports-and-publications/archives/semiannual/2013/SAR-F13-OS.pdf