Beware a pattern of errors waving a red flag. M0175 won't affect payment under the 2008 PPS refinements, but the OIG continues auditing. A new report from the
But the report also shows that the Centers for Medicare & Medicaid Services is likely to recover little by continuing to try to recoup post-edit M0175 overpayments, experts predict. The audit found that Medicare had overpaid the VNA Care Network of Worcester, MA, about $6,200 in 2004 and 2005 -- out of total claims paid in those years of about $437,000.
You can't rely on your fiscal intermediary's edits to prevent M0175 overpayments. Beginning in 2003, FIs implemented pre- and post-payment edits to catch M0175 errors in their favor. But of the 161 claims the VNA Care Network submitted with M0175 overpayment errors in fiscal years 2004 and 2005, the edit caught only 138 of them.
Note: The report (A-01-06-00514) is at http://oig.hhs.gov/oas/reports/region1/10600514.htm.