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Correct Medical Billing for Endoscopy Procedures

Correct Medical Billing for Endoscopy Procedures

Endoscopic procedures are getting a closer look by Medicare and Medicaid. The University of Rochester’s Strong Memorial Hospital submitted claims from September 2001 to December 2003 for endoscopic procedures that were found in an audit conducted by both agencies to be billed incorrectly.

In total costs, the hospital repaid over $500,000 combined to these organizations. There were two main reasons the medical billing was incorrect. Many of the procedures claimed that the head of surgeon, Ma 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.

This is more of a case of sloppy medical billing rather than outright fraud. However, the messy medical billing of the University of Rochester’s Strong Memorial Hospital may make Medicare and Medicaid scrutinize endoscopy claims much closer in the future and it may make getting reimbursed for this service difficult without ironclad medical necessity and backup documentation to show the necessity for the procedure.

If you don’t already, have your staff double check your medical billing or even smarter, partner with an outside medical billing company that already has the quality control measures in place to get your practice the maximum returns on your endoscopy procedures without the worry of audits or reimbursements from unwitting overpayments.

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