tci Medicare Compliance & Reimbursement - 2022 Issue Q1

Compliance: Fend Off Chart Blunders With Stellar Documentation

Ensure notes prove medical necessity to thwart MAC ire. If you utilize certain unique codes too often, that could be a problem. You may be labeled an outlier and catch the attention of auditors. Case study: One physician learned that lesson the hard way in January and was indicted by a federal grand jury after the Department of Justice (DOJ) accused her of defrauding Medicare out of $46 million on unnecessary balloon sinuplasty services (31295-31297). On Jan. 5, the DOJ reportedthat Raleigh, North Carolina ENT Anita Louise Jackson billed over $46 million to Medicare for at least 1,200...

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