Oops another Medicare scandal has rocked the healthcare industry!
Every now and then a Medicare scandal hits the headline and sends the healthcare industry into, a, frenzy. Ranging from carefully orchestrated scams to genuine mistakes and oversights, Medicare inspections and fines have almost become de-rigor. Recently a Michigan based gynecologic was in the news for overbilling routine visits.
The executive director of the American Medical Billing Association, Cyndee Weston, expressed concern over the physicians’ billing method. “I can’t see a situation where every visit would be a level 5, especially on an established patient”, she said. Physicians who are the black swans in the lake are more likely to be identified and penalized.
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Lost in a maze of templates?
A report by the US department of health and human services found that Level 4 visits have increased by 15% and conversely Level 3 visits decreased by 8 points. This shows that physicians have either been deliberately overbilling or have lost their way amongst the wilderness of pre-designed EHR billing templates.
Unhealthy developments…
There have been repeated complaints about EHRs fostering a culture of overbilling. They induce physicians to click and pick from a limited set of codes. Automatic alerts and auto-generation of codes is another reason why overbilling errors are on the rise. Cloning, carrying forward medical data, copy pasting records and relying too heavily on templates are one major reason for overbilling errors.
The Harvard affiliated CIRCO analysed 147 EHR related claims and found that inaccurate medical information topped the list of errors. Documentation errors mean erroneous claims erroneous claims can lead to overbilling errors which means the next time a Medicare audit is around the corner, your practice runs the risk of being penalized.
Medicare Auditor General MacPherson says that about 53% of Medicare payments are being audited.
5 strategies to avoid overbilling errors…
#1. Working with professional billers is the most obvious answer. CMS experts suggest that it is highly unlikely that physicians purposefully overbill insurers. Using the highest E&M code is being seen as the lack of knowledge about classifying visits. A professional collection or billing agency can bill within the stipulated guidelines.
#2. Electronic coding can lead to mistakes. Place of service, time of service and important modifiers are usually inaccurate. Even minor coding errors can drastically impact reimbursement. Check coding procedures periodically.
#3. Construct a compliance framework and create overbilling alerts within your EHR. Discuss with your vendor to develop a working plan.
#4. Audit voice transcripts and medical reports to spot and weed out errors earlier.
#5. Coordinate with insurers to stay updated about reimbursement changes and latest billing regulations.
