63 Billing and Coding Strategies for Avoiding Medicare False Claims

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Get indispensable help in avoiding Medicare billing and coding pitfalls that could subject you to very costly and time-consuming enforcement actions or result in a loss of revenues you're entitled to.

63 Billing and Coding Strategies for Avoiding Medicare False Claims is a comprehensive collection of practical articles — drawn from AIS's Report on Medicare Compliance — on false claims cases, government billing and coding investigations, and a wide range of Medicare billing and coding problems to avoid.

Supplemented with sample forms and worksheets, the articles in this report will guide you around many of the most common pitfalls in Medicare billing and coding, cost report errors, bad documentation, DRG upcoding, and other problems that can result in enormous fines and penalties against your organization.

 

Table of Contents

1. With CMS Move, Hospitals Face Money Loss for Multiple Push Injections of Same Drug
2. CMS: Hospital Can Charge Unused Room, Board for No-Show Patients
3. Proposed Rule Cracks Down on LTC Hospital Payments; Coding Errors Are Common
4. Hospitals May Risk MSP Overpayments When Billers Misuse Certain Value Codes
5. Value Codes Information for Hospital Billing
6. Time Is Ripe to Improve Modifiers 25 and 59 Compliance; OIG Audit Cites High Error Rate
7. Decison Trees for Proper Use of Modifiers 25, 59
8. Billing Errors Include Not Proving Medical Necessity for Stents
9. Reimbursement Status of Medical Nutrition Now Uncertain; CMS Throws Ball to FIs' Court
10. Hospitals Face Difficulty as New CPT Codes Collide With C Codes for Billing Infusion
11. Baylor's Expanded Review: 12 Risk Areas
12. Billing for Medical Nutrition Therapy
13. Allow One-Level Leeway in E/M Coding Differences
14. New Condition Codes for Device Surgery May Signal CMS Reimbursement Concerns
15. Processes for Provider Billing in Seven Situations
16. Final OPPS Rule: CMS Drops Imaging Cuts, Simplifies Observation Services Billing
17. One Expert's Observation Billing Tips
18. CMS Fixes DRG Window Error; Providers Should Test Compliance
19. Compliance Investigations Focus on Systems and Incidents; Look at Transfers, Drugs
20. Sample Observation Policy, Procedure
21. Documentation Stakes High With 12 New DRGs, MCVs; Pairs Pose Compliance Risk
22. New Stroke DRG Pays More, but Be Wary of Compliance Risks
23. Validating Discharge Status Codes
24. Hospitals Grapple With Cardiac Medical Necessity; OIG Finds Stent Billing Errors
25. Update Training, Policies to Ensure Drug Administration Compliance Amid Changes
26. Monitoring Will Get Tougher for Hospitals; CMS Extends Transfer Policy to 182 DRGs
27. DRGs Subject to Post-Acute Care Transfer Payment Policy
28. CMS Will Pay More for Severe Cardiac DRGs to Level Playing Field
29. CMS Changes Observation Game in 2006 OPPS Reg; Hospitals Will Be Happy to Play
30. CMS Changes Imaging, Drug, Prevention Payments in OPPS Rule; No E/M Coding Yet
31. With Some Inpatient Coding Still Weak, Look to Improve Oversight
32. 'Expanded Review Strategy' Helps Improve Baylor's Compliance Monitoring in 12 Areas
33. Auditing E/M Coding, Modifiers: Baylor's Activity Form
34. Auditing E/M Coding, Modifiers: Baylor's Decision Tree
35. Medicare Scrutiny Turns to DRGs With CCs, as Study Links CC Billing to Coding Errors
36. Medicare Watchdogs Intensify E/M Coding Scrutiny; New Audit Sources Are Available
37. Next Round of Hospital Payment Monitoring Program Is Set to Start, Has New Risk Areas
38. Worksheet to Help Hospitals Monitor OPPS Drug Billing
39. CMS Cracks Down on Billing for Physical Therapy 'Incident to' Physician Services
40. CMS: CPT Codes Will Replace Q Codes for Hospital Drug Administration Under OPPS
41. CMS Fund Is EMTALA Brass Ring; Hospitals Must Detail Illegal-Alien Status, Stabilization
42. CMS: Apply Start, Stop Time Definitions to All Observation; Separate Medical, Surgical
43. Interest Grows in Auditing Audits to Help Flush Out Errors, Improve Your Credibility
44. Guard Against Ripple Effects of Bed-Use Changes; Watchdogs Eye Cost-Report Fraud
45. Hospital's Nightmare Ends as Judge Rejects Fraud Allegations Related to Nurse Ratio
46. Billing Guidance for Replacing Certain Medtronic Devices
47. Hospital Gets Second Chance in Disclosure; Chart Review, Tools Cut Admission Errors
48. Medicare Watchdogs Eye Radiology Pay; More Registration Controls Suggested
49. CMS Revises APCs Again; Evolution of Observation Payment Continues
50. Admission Medical-Necessity Errors Abound; Hospitals Try New Compliance Strategies
51. CMS Implements 'Medically Unbelievable' Edits for Claims
52. Septicemia, Sepsis Coding Errors Are Prevalent; Use PEPPER to Flag Problems
53. OPPS, Ancillaries Stressed in OIG Guidance; Greater Compliance Oversight Necessary
54. Sample Orders for Outpatient Services
55. CMS Says Contractors Must Obtain More Documentation Before Denying Claims
56. CMS Adds Minimum Time of Care for APC Observation Payment
57. ASC Rules Have Hospital Implications; Track APC, ASC Pay Gaps for Same Procedures
58. ASC vs. APC Pay: Analyze Payment Differentials for Same Procedures
59. CMS Implements New System to Resolve Provider Billing Dilemmas
60. Case Review Gives Hospitals Some Bites of Payment Apple if They Produce Records
61. Some Medicare Auditors, Prosecutors Crack Down on Hospital Infusion Billing
62. Hospitals Get More Leeway in Billing Multiple Infusions
63. Hosptial OPPS Billing Is at Risk Over E/M Facility Fees, HCPCS Codes, Modifier 59

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