Audit Triggers to Watch Out For in 2008

In 2007 the OIG zeroed in on incident to billing claims. The HHS Office of Inspector General plans to issue a report on whether all the requirements for incident-to billing, including direct physician supervision are being followed. The OIG wants to know whether these services met the Medicare standards for medical necessity, documentation and quality of care, according to the OIG’s Work Plan. Other topics include:

Other things that will be closely studied in the report include global periods and how they are determined in the medical billing. The agency will also be in the lookout for assignment violations where the physician has billed the patient more than Medicare co-pays for a service. They will also be ascertaining if the physician is notifying patients of their right to not be overcharged.

Imaging services will also come under close scrutiny. Medicare paid out $7 billion in 2005 and will be looking at all imaging services for medical necessity and proper medical billing. To keep overpayments on this type of service at a minimum.

The popularity of eye surgery is also under the microscope of scrutiny. If the OIG suspects that you’re billing for cataract and LASIK eye surgeries in ways that don’t meet Medicare requirements, you could find yourself under audit and quickly. The smartest thing you can do is consult with a medical billing partner and make sure that every claim you file is to the letter proper and help you avoid setting off audit triggers.

View all Articles by: Melissa Clark, CCS-P