Pulmonology Coding Alert
OIG Is Watching Your Doctor's Nursing Home Visits
Part B payments 'vulnerable to fraud,' watchdog says Nursing homes could be hotbeds of inappropriate billings, a government agency says. Your doctor's Part B claims for services to patients who are in a nursing home but not during a Part A-covered stay are "particularly vulnerable to fraud and abuse," says the HHS Office of Inspector General in a new report (OEI-05-06-00240). Congress has asked the OIG to keep an eye on doctors billing for services that the nursing home may already be billing for separately. The OIG's new report (Medicare Part B Services for Nursing Home Residents) doesn't draw any conclusions. But it does point to a lot of money going to doctors billing in nursing homes, and that may indicate duplicate billings. Medicare paid $5.3 billion for Part B services for non-Part A nursing home patients. Ten services accounted for 79 percent of these billings. These included "minor procedure," "nursing home visit," "lab test," "specialist" and "standard imaging." The OIG says it will be looking at these areas and gathering more up-to-date information to figure out how many payments overlapped with services the nursing home billed.
Pulmonology Coding Alert
- Look for This $125+ Boosting Phrase in Diagnostic Scope Notes
Error averted: Drop 31575 when biopsy occurs Reporting 31575 when your pulmonologist actually performed 31525 [...] - You Be the Coder:
How to Weigh Vent Management Vs. E/M
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Medicare overspends millions on upcoded inpatient visits Carriers are scrutinizing your inpatient hospital visits more [...] - OIG Is Watching Your Doctor's Nursing Home Visits
Part B payments 'vulnerable to fraud,' watchdog says Nursing homes could be hotbeds of inappropriate [...] - Reader Question:
You Can Refer to MD-Owned Sleep Lab
Question: We are a pulmonology clinic plus a sleep lab with two beds, and we [...] - Reader Question:
Stick With Nonspecific Code for MIPs & MEPs
Question: What is the correct way to bill for maximum inspiratory pressures (MIPs) and maximum [...] - Reader Question:
Must You Always Follow NCCI Edits?
Question: When specialty society guidelines differ from National Correct Coding Initiative edits, a commercial payer [...] - Reader Question:
Report Bilateral 32002 on One Line
Question: I submitted documentation with a line-itemized claim for three same-day services/procedures as follows:
--99233-25 (Hospital [...] - Reader Question:
Look Beyond HPI for Chronic Condition:
Question: The 1997 audit guidelines state that I can reach an extended history by updating [...] - Reader Questions:
Use This Diagnosis for Asthma With Croup
Question: An established patient with a history of asthma who is now taking Albuterol presents [...] - Prove Patient Is 'Critical' When You Report 99291
CPT considers many services part of the critical care package When deciding whether your pulmonologist [...]
