tci Medicare Compliance & Reimbursement - 2023 Issue Q4

Compliance: Cataract Surgery Remains Popular Medical Review Topic

Find out the codes the MACs are targeting in their TPE reviews. Cataract surgery claims continue to sit atop auditors’ to-do lists. And because that scrutiny doesn’t seem to be going away any time soon, you may want to review the codes they’re looking at as well as the probe results from recent prepayment claims reviews. TPE: Over the past year, most of the Medicare Administrative Contractors (MACs) have either completed Targeted Probe and Educate (TPE) probes of cataract removal claims or have added them to their active topic lists. The specific code(s) included in the audit...

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