Archive for category Audits
New legislative proposal magnifies the significance of clean claims
Posted by Bryan Koch in Audits, Legislation, Medicare on November 30th, 2009
Medicare “waste” and “improper payments” are no strangers to the governmental spotlight. This time it shines on them in the form of legislation just introduced by Sen. Charles Grassley (R-IA) called the Fighting Medicare Payment Fraud Act of 2009.
This bill is one you may want to watch closely. The reason: it would allow payment delays of up to one year if the government suspects waste, fraud or abuse – essentially circumnavigating current prompt payment rules.
“Because of this prompt payment rule, the government puts itself in a position of having to pay and chase Medicare fraud, instead of working to prevent it in the first place,” Grassley says in a press release introducing the bill. So, Grassley proposes to “…give the Secretary of Health and Human Services authority to extend the time period in which payments must be made under the prompt payment rule if the Secretary determines there is a likelihood of fraud, waste or abuse. With this additional time, the Secretary would be required to conduct more detailed reviews of the claims in question to make sure they are supposed to be paid.” Read the rest of this entry »
Use technology to aid – not substitute for – self-audits
Posted by Ken Bradley in Audits, EMR, Health Information Technology on October 30th, 2009
In this age of automation, it is tempting to rely on technology solutions to ease the burden of coding operations. And that’s OK; that’s the purpose behind the many extremely valuable coding and documentation tools available from many EMR applications.
However, I’d like to offer one caveat: Please don’t allow confidence in technology to detract from the value of self-audits. Technological aids don’t render coding and billing audits obsolete. As advantageous as some coding tools are, ongoing self-evaluation remains the single best way to ensure optimal coding practices – those that garner appropriate reimbursement while also protecting against payer investigations.
Take, for instance, evaluation and management visits (otherwise known as E/M services). They are the lifeblood of many practices, yet they still account for a significant portion of the errors found in Medicare’s Comprehensive Error Rate Testing (CERT) audits. Perhaps that accounts for certain E/M services remaining on the Office of Inspector General (OIG) Work Plan for 2010. Read the rest of this entry »