Proper Coding Of Arterial Stent Avoids Audits

Proper Coding Of Arterial Stent Avoids Audits

A medical billing audit on arterial stents could highlight your coding errors. It is important when billing to provide the most accurate and up to date medical coding possible. To ensure all medical payments are correct, proper arterial stent billing is necessary.

Recently, the HHS Office of Inspector General did an audit for claims processed in 2002 for arterial stents. These medical billing claims were all from Texas providers processed by the contractor called Trailblazer Health Enterprises, LLC. Out of seventy two arterial stent bills, twenty of them were incorrectly processed by Medicare. This billing resulted in a medical over payment of over $35,000 to fifteen different Texas providers.

The reasons these medical claims were overpaid were several fold. Some did not have sufficient documentation of medical necessity in the medical billing records. Other claims had services provided that were not supported by the patients’ medical records at all. The third reason for these medical billing over payments is the most important. Seven claims were coded incorrectly.

Each and every one of the Texas providers had to pay back the over payment money. It seems the practices were not properly educated on the medical billing requirements for the Centers for Medicare & Medicaid Services. Those providers will be educated in the future.

These medical billing errors in Texas and in other states can be avoided. There are specific medical billing companies that can take care of your billing responsibilities. They have trained personnel and specific software that can detect and prevent claim errors. Medical billing firms can decrease the lag time for reimbursement and prevent reimbursement errors in the future.

Whether your practice decides to educate it’s personnel, or you choose to outsource your medical billing, coding for arterial stents must be correct to avoid audits.

View all Articles by: Melissa Clark, CCS-P