Check Endoscopic Medical Billing Claims Twice

Check Endoscopic Medical Billing Claims Twice

Endoscopic procedures may be a sore subject for some medical billing professionals. Medicare and Medicaid may keep a closer eye on these services for the time being. The University of Rochester’s Strong Memorial Hospital submitted claims from September 2001 to December 2003 for endoscopic procedures that were wrongfully billed. Learn from other’s mistakes and don’t let your endoscopic medical billing get out of control.

Not only was this New York hospital audited once by Medicaid, but it was audited again by Medicare. In total costs, the hospital repaid over $500,000 combined to these organizations. There were two reasons the medical billing was incorrect. Many of the procedures claimed that the head of surgeon, Uma Sundaram, performed the surgeries. In all actuality, most of the time, the head surgeon was not even present. The other reason the medical billing was incorrect was because medical necessity was not substantiated for procedures in many of the medical records.

The negligence of the University of Rochester’s Strong Memorial Hospital may just make CMS take a closer look at all endoscopic claims. With this in mind, make sure each and every claim, especially endoscopic claims, are submitted with correct medical billing every time. This will prevent future audits and possible future repayments.

Get in the habit of checking and double checking claims before they are submitted to payers. A little extra time in the medical billing department could save days or weeks of headache. Be sure all medical necessity is substantiated either with medical billing codes or with accompanying medical records. There is nothing worse then having the integrity of your medical practice compromised merely because your medical billing personnel didn’t want to be meticulous. Do you medical billing job correctly and you will get correctly compensated for your efforts.

View all Articles by: Melissa Clark, CCS-P