tci Medicare Compliance & Reimbursement - 2015 Issue 9

Compliance: Will You Be the Next Target for Repayments?

Improper payments for ESRD on auditors’ radar. The Centers for Medicare & Medicaid Services (CMS) recently published some results of government auditors’ findings in its April 2015 Medicare Quarterly Provider Compliance Newsletter. From routine errors like the physician forgetting to sign the order to lack of face-to-face documentation, the audit contractors found many issues with claims submitted for end-stage renal disease (ESRD) services. Insufficient Documentation Among Biggest Errors The Medicare auditors performed a “special study” of the 90960-90961 series, which relate to ESRD services for patients 20 years of age or older who see their practitioners for face-to-face...

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