Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Feds Create Another Medicare Fraud Strike Force Team to Fight Opioid Crisis

Published on Tue Nov 20, 2018

Plus: Input this new flu vaccine into your code checklist.

Over summer, the Department of Justice (DOJ) added a Strike Force team in Philadelphia. The feds are adding another regional group to cover Appalachia with two bases in Nashville, Tennessee and Cincinnati/Northern Kentucky, indicated the Office of Inspector General (OIG) in a release.

However, the new team will focus on illegal opioid prescriptions, the OIG maintains. “While the opioid epidemic continues to inflict untold pain and suffering on people across the country, the devastation in the Appalachian region and adjacent areas has been particularly staggering,” said Brian A. Benczkowski, Assistant Attorney General in the DOJ Criminal Division.

The mission of the Appalachian Regional Prescription Opioid (ARPO) Strike Force “is to identify and investigate health care fraud schemes in the Appalachian region and surrounding areas, and to effectively and efficiently prosecute medical professionals and others involved in the illegal prescription and distribution of opioids,” the DOJ says.

The ARPO location joins the already existing Medicare Strike Force cities of Miami; Los Angeles; Detroit; Houston; Brooklyn, New York; Baton Rouge and New Orleans, Louisiana; Tampa, Florida; Chicago; and Dallas, along with a Corporate Strike Force in Washington, D.C., the DOJ says.

In other news…

This year, you’ll need to add 90689 (Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use) to your list of flu vaccine codes.

Billing alert: If you’re billing Medicare for the service, you should note the billing dates for the code. “The new influenza virus vaccine code 90689 is not retroactive to August 1, 2018. No claims should be accepted for influenza virus vaccine code 90689 between the DOS August 1, 2018, and December 31, 2018. If claims are received in January 2019 with code 90689 for DOS between August 1, 2018, and December 31, 2018, [Medicare Administrative Contractors] will follow their normal course of action for codes billed prior to their effective date,” according to CMS.

Resource: See MLN Matters release MM10871 for more information about the vaccine at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10871.pdf.