Compliance: Will You Be the Next Target for Repayments?

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews Medicare compliance findings from CMS and government auditors related to end-stage renal disease services and transcatheter aortic valve replacement/implantation claims. It is useful for coders, billing staff, compliance teams, and providers who want to understand the kinds of documentation and claim-review issues that have drawn audit attention and repayment risk. The discussion focuses on the general categories of errors identified in the audit findings and the types of services involved.

Why This Topic Matters

The article helps readers recognize where Medicare audit scrutiny has been focused and why incomplete records or mismatched documentation can place claims at risk. It is relevant for organizations that bill ESRD and TAVR/TAVI services and need to monitor compliance exposure.

What You Will Learn

  • What Medicare audit findings showed about claim review focus areas
  • Which general documentation issues were associated with payment problems
  • How audit findings related to ESRD and TAVR/TAVI services
  • Why coding and record support are central to compliance risk

Who Should Read This

  • Medical coders
  • Billing staff
  • Compliance professionals
  • Physicians and clinical documentation staff
  • Revenue cycle teams

Codes Discussed

  • CPT: 90960
  • CPT: 90961
  • CPT: 33361
  • CPT: 33362
  • CPT: 33365
  • HCPCS Level II: 0318T

Code Ranges Discussed

  • CPT: 90960-90961
  • CPT: 33361-33362

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