Part B Insider (Multispecialty) Coding Alert

The feds are watching place-of-service codes

Physician Practice that perform ambulatory surgical procedures in their offices should make sure their coders know the ropes when it comes to place-of-service codes.
 
The HHS Office of Inspector General is worried that physician practices are collecting more Medicare reimbursement than they deserve due to place-of-service coding errors, particularly in New England. In a recent audit report titled "Review of Payments Made by National Heritage Insurance Company for Ambulatory Surgical Procedures for Calendar Year 2001" (A-01-02-00524), the OIG points out that Medicare makes higher payments for ASPs performed in non-facility settings (e.g., in the physician's office) than it does for those performed in facility settings such as hospitals or freestanding ambulatory surgical centers. The extra money is designed to compensate doctors for the extra costs they incur by doing the procedures in their offices.
 
However, the OIG contends that many practices are overbilling for ASPs because physician-billing personnel didn't establish "adequate controls to prevent the incorrect billing of the place-of-service code for ASPs." Those practices are now likely to face overpayment demands, since the OIG urged NHIC to pursue any excessive reimbursement claimed for ASPs.
 
To see the report, go online to http://oig.hhs.gov/oas/reports/region1/10200524.pdf.