I have done billing so I am qualified I feel to comment here. Most procedures done by family practice and other specialists “do” occur in the office which is coded as an “11”. If they leave their offices and travel to a hospital or out patient surgical center let’s not forget the time they have to take to leave their office and drive over there too, but with providing that service outside the office this is what they do for free on travel time.
Most billing software today has a template you prepare for patients and thos
e who are in facilities are automatically coded properly when the template is generated. Many patients have both Part A and Part B or it can be combined into an advantage plan Part C, add on prescriptions and now you can have Part D.
Multiple services can get confusing here too with a patient that has both Part A and Part B and part of one claim may involve both office visits and a trip to the hospital, so maybe we have a Part C here too.
When a trip to the hospital occurs, then doctors coordinate coding in the case of a specialist becoming involved in the patient case. After reading this I think there’s a real good possibility of some combined claims and questions as to which service took place at which location, as this stuff happens and fitting it into the correct data tables can be a challenge at times. A follow up visit after hospitalization at the office is pretty standard too so now we are at an 11 which is back at the office.
In short what I am saying is that some of the coding are legitimate mistakes and this should not be a big sensational story about doctors ripping off Medicare as this is common and not done intentionally. Think about it this way, every time you visit your doctor he/she is filing a 1040 tax form, some are short versions, some are itemized and some get audited, it’s just about the same thing and just think you only file taxes once a year, but the the medical billing business 1040s are flying out every 15 minutes with compliance on 100% accuracy being critiqued. Here’s a good example of a peer group, the hospital and the doctors having no clue in how to interpret a coding situation that reflected on how to bill it and this is common too.
Hospitalists, Peer Committees and Utilization Struggle to Comprehend United HealthCare Algorithms
Certainly there may some fraud and those folks need to be caught, but gee most of this is just the complicated coding of medical billing and the story deserves a much better attention line here than rather being a “crack down” on those doctors. It’s a legitimate issue and HHS should be aware of this and less emphasis on enforcing and more on helping individuals code in our complicated system. BD
WASHINGTON – The Department of Health and Human Services, Office of the Inspector General is recommending that the federal government crack down on physicians who have incorrectly coded their Medicare claims for the wrong place of service.
A new OIG HSS audit has found that Medicare contractors nationwide overpaid physicians $13.8 million for incorrectly coded services provided during calendar year 2007.
HHS to crack down on miscoded Medicare claims | Healthcare IT News
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