tci Medicare Compliance & Reimbursement - 2011 Issue 10
Compliance: OIG Finds 69 Percent Error Rate in New Outpatient Audit
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Article Overview
This compliance article reviews an OIG report on Medicare Part B outpatient claim payments processed by a Medicare Administrative Contractor. It focuses on the types of billing and coding problems identified in the audit, the scale of the resulting overpayments, and general practices providers can use to reduce error risk and respond to payment discrepancies. The article is relevant to billing staff, coders, compliance teams, and outpatient practices that submit HCPCS-based claims.
Why This Topic Matters
The article helps readers understand the kinds of outpatient claim errors that can trigger audit findings, repayment demands, and closer MAC review. It is useful for organizations seeking to improve claim accuracy, monitor payment anomalies, and strengthen compliance processes.
What You Will Learn
- What an OIG outpatient audit examined
- What broad categories of claim errors were found
- Why payment discrepancies can create compliance risk
- What general billing controls can help reduce overpayments
Who Should Read This
- Medical coders
- Billing specialists
- Compliance officers
- Revenue cycle staff
- Outpatient practices
- Part B providers
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