ED Coding & Reimbursement Alert - 2015 Issue 2
OIG Hot List: Misuse of Modifier AA Could Land You In Hot Water
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Article Overview
This piece reviews a 2015 Office of Inspector General Work Plan topic that is relevant to anesthesia practices, outpatient surgery settings, and billing staff who manage Medicare claims. It explains the general areas the OIG planned to review, including anesthesia modifier usage and place-of-service coding, and why those issues drew scrutiny in the context of Medicare payment accuracy.
Why This Topic Matters
The article helps readers quickly assess whether they need to review anesthesia billing and place-of-service reporting processes in light of OIG audit attention. It is especially relevant for anesthesiology offices, ASC billing teams, and hospital outpatient claim preparers.
Article Sections
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Background
Introduces the OIG Work Plan and the general review areas being emphasized for the fiscal year. Sets up the article’s focus on anesthesia claims and claim accuracy.
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Differentiate ‘AA’ From ‘QK’ Modifier
Discusses OIG attention to anesthesia claims and the broader issue of reporting accuracy on Medicare claims. Frames the section around modifier scrutiny without disclosing specific coding advice.
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Know Your Place of Service
Covers place-of-service reporting issues for services performed in different outpatient and office settings. Highlights the article’s emphasis on aligning claim data with the actual service location.
What You Will Learn
- What the 2015 OIG Work Plan highlighted for review
- Why anesthesia claim reporting drew audit attention
- How place-of-service reporting fits into Medicare claim accuracy
- Which practice settings are most affected by the guidance discussed
Who Should Read This
- Anesthesiologists
- Anesthesia billing staff
- Medical coders
- Revenue cycle professionals
- ASC billing teams
- Hospital outpatient billing departments
Codes Discussed
Modifiers Discussed
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