Part B Insider (Multispecialty) Coding Alert

Plus: CMS refers ICD-10 date-span questions to local MACs.

Making house calls isn’t known as being especially lucrative—unless the physician in question pumps up his or her charges exponentially higher than a legitimate service would pay. Such is the case in question that was part of a $2.568 million alleged fraud ring that involved several Midwestern physicians and their mobile physician services.

The service was known for making house calls in six states, but the doctors who performed the in-home patient visits allegedly charged for services that were significantly more complicated and time-consuming than what they actually performed. In addition, some patients were not actually confined to their homes, allowing home healthcare agencies to bill for additional services even though these patients were not legally qualified to receive the care.

The house-calling doctors apparently billed 99 percent of all established-patient visits using the two highest codes (99214 and 99215). One former employee of the mobile doctors told federal investigators that the doctor said 99214 was “the default code” for patient visits to support the gasoline and time spent seeing the patient.

The physicians involved face between five and ten years in prison if convicted. To read the entire news release about the arrests, visit www.justice.gov/usao/iln/pr/chicago/2013/pr0827_01.html.