Don’t Get Burned by a Government Audit

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Dont Get Burned by a Government Audit
Speaker Nikki Taylor, MBA, CPC, COC, CPMA,
CRC, AAPC Fellow
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Learning Objectives

• Get the inside scoop on top billing errors
• Learn the ins and outs of CMS new TPE program
• Get to know whats new at OIG
• Gain practical advice on how to discuss
  government compliance with your providers
• Highlight helpful tools and resources

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Top Billing Errors, cont.

1. Invalid procedure and diagnosis codes
2. Multiple E/M services billed within same group
3. Billing services without qualifying service or
   procedure

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Top Billing Errors, cont.

• Invalid Procedure and Diagnosis Codes
• Pay attention to annual code revisions
• ICD-10-CM codes go into effect on Oct. 1
• CPT codes go into effect on Jan. 1
• Review new, deleted, and revised codes,
• Ensure your systems are updated

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Top Billing Errors, cont.

• Multiple E/M services billed within same group
• Physicians in the same group practice and of the
  same specialty
• MUST bill and be paid as a single physician
• Visit documentation must be billed as a combined
  visit for reporting purposes
• Example 1 Patient sees two providers on the same
  DOS
• Example 2 Patient sees one physician for a
  procedure and then sees another physician w/in
  the same practice w/in 3 years

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Top Billing Errors, cont.

• Billing services without qualifying service or
  procedure
• Remember the rules for add-on codes
• Not payable without qualifying service or
  procedure
• Example CPT code 44203
• Bill first CPT code 44202

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CERT Top Billing Errors

• CMS Quarterly Provider Compliance Newsletters
  2017
• Updated Quarterly
• January
• April
• July
• October
• Top compliance issues found by CMS

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CERT Top Billing Errors, cont.

• Retinal Photocoagulation
• CPT Code 67228
• CERT conducted a special study of retinal
  photocoagulation procedures
• Billed with 67228
• Submitted from July through September 2015

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Resources

• https//www.cms.gov/Outreach-and-Education/Medicar
  e-Learning- Network-MLN/MLNProducts/MLN-Publicati
  ons.html
• https//www.cms.gov/Research-Statistics-Data-and-
  Systems/Monitoring-Programs/Medicare-FFS-Complian
  ce- Programs/Medical-Review/Targeted-Probe-and-Ed
  ucateTPE.html
• https//oig.hhs.gov/compliance/compliance-resource
  -portal/
• https//oig.hhs.gov/oas/reports/region9/91602026.p
  df
• https//oig.hhs.gov/reports-and-publications/workp
  lan/index.asp
• https//www.novitas-solutions.com
• https//orthoinfo.aaos.org/en/diseases--conditions
  /rotator-cuff-

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tears/
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PPT https//www.supercoder.com/medical-coding-web
inars/dont-get-burned-by-a-government-audit
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