Medicare Compliance & Reimbursement
OIG CONTINUES TO FRET OVER MULTIPLE PROCEDURE CLAIMS
As part of an extensive series of reviews on how well Medicare contractors handle Medicare claims from ambulatory surgical centers, the HHS Office of Inspector General has taken the measure of six carriers’ processing of multiple procedure claims.
The results, as in other reviews, suggest that Medicare claims processors will be taking a closer look at ASC claims for multiple procedure claims performed in a single surgical session.
Under Medicare rules, when multiple services are provided in the same operative session, the highest-paying procedure gets reimbursed in full while the others get paid at one-half the normal rate.
However, all six contractors reviewed in the most recent round of audits failed to handle such claims properly. According to the reports, each titled “Review of Claims for Multiple Procedures Performed in the Same Operative Session in Ambulatory Surgical Centers” (A-07-03-02653, A-07- 03-02658, A-07-03-02660, A-07-03-02661, A-07- 03-02663, A-07-03-02665 and A-07-03-02666), the contractor-specific overpayments identified ranged from $35,846 to $776,271.
The reports analyze claims submitted between 1997 and 2001 to Arkansas Blue Cross and Blue Shield, Empire Medicare Services, National Heritage Insurance Company of California, National Heritage Insurance Company of New England, Palmetto Government Benefits Administrators, Wisconsin Physicians Service Insurance Corp. and HGSAdministrator.
To see the reports, go to http://oig.hhs.gov/oas/oas/cms.html.
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