tci Medicare Compliance & Reimbursement - 2008 Issue 8

Compliance: Wondering Why MUEs Matter?Recent Audits Show You

Watch those big-ticket claims or the OIG will watch for you If big-ticket claims are your practice's bread and butter, keep in mind that the OIG is watching carefully. A string of recent OIG audits shows just how attuned the agency is to high-dollar errors, and demonstrates a possible reason why the Correct Coding Initative's (CCI's) new medically unlikely edits (MUEs) were imposed. For example, according to the OIG's Jan. 4 audit report of Group Health Inc. (GHI), a Part B payer in Queens County, NY, the agency reviewed 14 "high-dollar" payments to providers (claims resulting in payments of...

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