Healthcare News: Medicare overpaid beneficiaries $1.9 million for CCM, says OIG

August 24th, 2021

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This article covers an Office of Inspector General review of Medicare chronic care management billing and the resulting overpayment concerns. It explains the general compliance context for CCM services, the categories of overlapping services involved, and the kinds of CMS process changes and provider notifications the report recommends. The piece is relevant to coders, compliance staff, billing managers, and Medicare providers who work with chronic care management claims.

Why This Topic Matters

It highlights a Medicare audit finding tied to CCM billing oversight and points to areas where claims processing and provider compliance practices may need review.

What You Will Learn

  • The Medicare compliance issues associated with chronic care management billing
  • How OIG audit findings can affect CCM claim processing and provider oversight
  • The types of CMS safeguards discussed in response to overlapping care management billing
  • The general reporting context for chronic care management services under Medicare

Who Should Read This

  • Medical coders
  • Coding auditors
  • Compliance officers
  • Revenue cycle staff
  • Medicare billing specialists
  • Physicians and other qualified healthcare professionals
  • Health systems and practice managers

Codes Discussed

  • CPT: 99490
  • CPT: 99487
  • CPT: 99489
  • HCPCS Level II: G0181
  • HCPCS Level II: G0182

Code Ranges Discussed

  • CPT: 90951—90970

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