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Federal government scrutinizes Medicare billing accuracy
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Physicians had a poor accuracy rate in billing Medicare for evaluation and management services in 2010, according to the Office of Inspector General Report Card, Kevin J. Corcoran, COE, CPC, CPMA, FNAO, said at Hawaiian Eye 2015.
The report, released in May 2014, showed that 42% of claims were incorrectly coded and 19% of claims lacked documentation, Corcoran said. He noted that the report did not include improper payments for surgery and diagnostic testing. The improper payments totaled $6.7 billion, Corcoran said.
The OIG also reported improper Medicare payments for FY 2014, Corcoran said.
“The annual Health and Human Services Agency financial report for FY 2014 revealed error rates of 12.7% for Part A and B Medicare, 9% for Part C Medicare and 6.7% for Medicaid,” Corcoran said in a subsequent interview with Ocular Surgery News.
The 2015 OIG Work Plan designates several targets for scrutiny in ophthalmology and optometry, Corcoran said. The targets are place of service errors; payments for drugs; ASC payments; questionable billing for ophthalmologic services in 2012; imaging services; Medicare electronic health record payments; anesthesia services; payment for compounded drugs under Medicare Part B; and the security of certified electronic health record technology under the Meaningful Use incentive program.
“Of particular interest within the plan are payment for compounded drugs, ophthalmologic services, imaging services and security of electronic health records,” Corcoran said.
Sunshine Act
The Physician Payments Sunshine Act is in effect, with the first set of disclosures posted on a CMS website, Corcoran said.
The initial reporting period was Aug. 1, 2013, to Dec. 31, 2013. CMS posted the first round of payment disclosures online on Sept. 30, 2014.
“Under the Physician Payments Sunshine Act, implemented in 2014, manufacturers of a drug, device, biological or medical supplies participating in federal health care programs will have to report to CMS any direct payments or transfers of value to physicians and/or teaching hospitals of $10 or more,” Corcoran said. “CMS will post payments or other transfers of value and ownership or investment interest reports on a public website. Physicians should check the CMS website to verify data and track internally any payments and items of value received from manufacturers. Be prepared to discuss this information with the press and with patients.”
Recovery Audit Program
In February 2014, CMS announced a “pause in operations” for the Recovery Audit Program. Some automated reviews restarted in August 2014. CMS is negotiating new contracts for recovery audit contractors.
The Recovery Audit Program is designed to detect and correct improper Medicare payments.
“It is important that CMS transition down the current contracts so that the recovery auditors can complete all outstanding claim reviews and other processes by the end date of the current contracts. In addition, a pause in operations will allow CMS to continue to refine and improve the Medicare Recovery Audit Program,” Corcoran said.
“Several years ago, CMS made substantial changes to improve the Medicare Recovery Audit program. CMS will continue to review and refine the process as necessary,” he said. “For example, CMS is reviewing the Additional Documentation Request limits, time frames for review, and communications between recovery auditors and providers. CMS has proven it is committed to constantly improving the program and listening to feedback from providers and other stakeholders.” – by Matt Hasson
For more information:
Kevin J. Corcoran, COE, CPC, CPMA, FNAO, can be reached at Corcoran Consulting Group, 560 East Hospitality Lane, Suite 360, San Bernardino, CA 92408; email: kcorcoran@corcoranccg.com.Disclosure: Corcoran is president of Corcoran Consulting Group.