ED Coding & Reimbursement Alert - 2004 Issue 43
Compliance: Goodies In Fee Schedule Could Leave You A Fat Target For OIG
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Article Overview
This article reviews selected compliance-related provisions in the 2005 Medicare Physician Fee Schedule that may draw Medicare audit scrutiny or create billing liability. It is aimed at physicians, oncology practices, compliance staff, and office-based providers who bill for evaluation and management services or furnish physical therapy in the office. The discussion focuses on broad policy implications, documentation concerns, and staffing requirements rather than detailed coding instructions.
Why This Topic Matters
Providers need to understand which new fee schedule benefits and office-based service arrangements may attract audit attention, documentation review, or false-claim exposure. The article highlights areas where reimbursement policy, carrier guidance, and staffing qualifications could affect billing compliance.
What You Will Learn
- What compliance concerns are associated with selected 2005 Physician Fee Schedule provisions
- How Medicare audit risk may affect documentation expectations for demonstration projects
- Why office-based physical therapy staffing arrangements are discussed in a compliance context
- What kinds of provider groups may be affected by the fee schedule changes
Who Should Read This
- Physicians
- Oncology practices
- Compliance officers
- Medical billers and coders
- Practice managers
- Healthcare attorneys
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