›› Pecos Clarification
The previous announcement made by the Centers for Medicare & Medicaid Services (CMS) that beginning January 3, 2011, claims for certain ordered/referred Part B items and services will not be paid...
Coding Myths Debunked
Jennifer Hume, CPC,CPCO, CPMA, CEMC, Vice President of auditing and compliance for the American Academy of Professional Coders (AAPC)/Physician Services in Salt Lake City, warns that healthcare administration professionals are coming under increasing scrutiny for coding. She has recently shared a list of what she describes as common, long-standing coding myths. She has listed a few of the myths below.
Myth #1:
Undercoding prevents audits. Some professionals believe that purposely undercoding a procedure, practices remain under the audit radar. "The thought is, 'I can't be overpaid, therefore I can't have a problem,'" Hume says. But this is not true. Not only does it result in lost revenue for the providers, it can also prompt an audit. "It can be a red flag to auditors because you become an outlier in comparison to other practices, which can get you noticed," she says. "And you are literally throwing money out the door."
Myth #2:
Payment equals accuracy. Never assume that because a claim is paid, that you are safe from an audit, Hume warns. A recent error report produced by the Centers for Medicare & Medicaid Services (CMS), notes a 9.9 percent error rate in Carrier Part B services billed and paid."The number one reason for an audit was insufficient documentation on bills submitted for payment" Hume says. Those bills accounted for $3.74 billion.
Myth #3:
Because I am non par with Medicare, I am not at risk for Medicare recovery audit contractor (RAC) audits. Because of the recent RAC audits, fraud control units in public and private insurance companies are increasing their efforts to collect their money. In 2009, $510 million was recovered by Blue Cross Blue Shields fraud unit. For every $1 invested in the program, the payer recouped $7.
Myth #4:
Size matters. Even the smallest practices can be audited. Even small practices with two to five physicians can be audited by RAC's. And Medicare RAC's can request 10 records for review every 45 days.
Source: MGMA Connexion, March 2011; Coding myths debunked
For more imformation please call us at 877-845-3606 or email us: