General Surgery Coding Alert - 2008 Issue 10
PHYSICIAN NOTES: UHC Providers--Accredit Your Imaging Facility or Face Denials
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Article Overview
This brief physician-focused update explains upcoming UnitedHealthcare accreditation requirements affecting certain outpatient imaging providers and highlights two Medicare-related oversight topics: a hospital outpatient audit by the OIG and a CMS fraud-prevention transmittal. It is relevant to billing staff, imaging practices, hospital outpatient departments, compliance teams, and coding professionals who track payer policy changes and audit trends. The article provides a broad overview of payer accreditation expectations, audit findings, and inter-contractor fraud-fighting efforts without giving detailed coding guidance.
Why This Topic Matters
Readers in imaging, hospital outpatient billing, and compliance need to know about payer accreditation expectations and government audit activity because these can affect reimbursement, denial risk, and operational planning.
Article Sections
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Imaging accreditation and reimbursement update
Summarizes UnitedHealthcare’s updated requirements affecting outpatient imaging providers and the organizations involved in the accreditation process.
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OIG hospital outpatient audit findings
Reviews a government audit of hospital outpatient claims and describes the broad categories of payment errors identified.
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CMS fraud-fighting initiative
Notes a CMS transmittal describing a fraud-prevention effort involving contractor coordination and regional program integrity concerns.
What You Will Learn
- How payer accreditation changes can affect outpatient imaging reimbursement
- What broad issues were identified in a hospital outpatient audit
- What the CMS fraud-fighting initiative is about at a high level
- Which organizations are mentioned in relation to accreditation and oversight
Who Should Read This
- Physician office staff
- Imaging facility administrators
- Medical coders
- Billing and reimbursement specialists
- Compliance professionals
- Hospital outpatient billing teams
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