Healthcare News: OIG audit shows 92% of hospitals billed modifier -59 incorrectly for right heart catheterizations

April 10th, 2017

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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 healthcare news item reviews an Office of Inspector General audit focused on hospital billing practices for outpatient right heart catheterizations performed during the same encounter as heart biopsies. It is relevant to hospital coders, compliance teams, revenue integrity staff, and auditors who monitor Medicare billing accuracy, modifier use, and potential overpayment exposure. The article also covers the OIG’s recommendations to CMS regarding provider education, claim review, recovery of overpayments, and notification related to the 60-day rule.

Why This Topic Matters

The report highlights a widespread billing compliance issue affecting hospital claims and potential repayment risk. It matters to organizations that need to evaluate modifier use, audit findings, and Medicare overpayment response processes.

What You Will Learn

  • What the OIG audit examined in hospital outpatient billing
  • Why modifier use was a focus of the review
  • How the report connects billing practices with Medicare overpayment concerns
  • What CMS-related actions were recommended in response to the audit

Who Should Read This

  • Hospital coders
  • Compliance officers
  • Revenue integrity teams
  • Billing managers
  • Auditors
  • Healthcare reimbursement professionals

Modifiers Discussed

  • CPT: -59

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