Part B Insider (Multispecialty) Coding Alert

Plus: OIG crackdown on referral bribes nets $12 million in recovery

The Medicare Learning Network (MLN) aims to assist providers and their staff members with the tools to overcome the complexities of the Medicare system, and the latest variety of offerings from webinars and forums to videos and explanations can help you get a handle on these often-confusing topics.

As most medical practices know, proper documentation is key to collecting the correct payment for the services you render, and the MLN Publications and Multimedia unit provides a series that can help you document appropriately. The CMS Provider Minute videos offer details for avoiding incorrect billing and keeping your claims compliant.

Recent tips include advice on coding and billing CT scans, providing hospital discharge day management services, avoiding duplicate claims, and correctly reporting lumbar spinal infusions. The tip videos typically run just two to three minutes long but provide excellent advice that you can use to stay compliant at your practice.

Resource:  For the quick link to these MLN educational videos, visit https://www.youtube.com/playlist?list=PLaV7m2-zFKpigb1UvmCh1Q2cBKi1SGk-V.

In the news…

OIG continues to radar in on Medicare referral fraud that is so prevalent in the healthcare industry today.

A New York physician practicing in Nassau County was found guilty of taking bribes for referring patients to a diagnostic lab in New Jersey. The bribes ranged from concert and sporting events tickets and expensive meals to monetary payment for the kick-backs. The total amount of business he referred to the lab resulted in over $909,000 in improper Medicare payments.

Unfortunately, the fraud didn’t stop with this one provider, who was just one piece of a bigger Medicare-scheming machine, which included over 39 offenders, 26 of whom were physicians.

“Its organizers have admitted [the kick-back operation] involved millions of dollars in bribes and resulted in more than $100 million in payments from Medicare and various private insurance companies,” reports the Department of Justice, US Attorney’s Office, District of New Jersey, “It is believed to be the largest number of medical professionals ever prosecuted in a bribery case. The investigation has to date recovered more than $12 million through forfeiture.”

The physician has been given a hefty fine and will be serving 37 months in prison followed by a year of supervised release for his part in the payment for test-referrals scheme. 

Resource: For the complete OIG report on this sentencing, visit https://www.justice.gov/usao-nj/pr/new-york-doctor-sentenced-37-months-prison-taking-bribes-test-referral-scheme-new-jersey.

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