BC Advantage - 2015 Issue 11

OPHTHALMOLOGY AUDITS: IS YOUR PRACTICE READY FOR A MEDICARE AUDIT?

Robert W. Liles, JD, MS, MBARecently, the Department of Health and Human Services (HHS), Office of Inspector General (OIG) released a study entitled "Questionable Billing for Medicare Ophthalmology Services." As the study findings reflect, the OIG concluded that for the year 2012, approximately $171 million of the Medicare payments made that year for ophthalmology services were improper. As a result, OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) increase the oversight of its contractors over ophthalmology providers. From a practical standpoint, this means that CMS will be shortly tasking either its Zone Program Integrity...

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