tci Medicare Compliance & Reimbursement - 2012 Issue 12
Industry Notes: OIG Audit Finds Only 15 Percent of E/Ms With Eye Injections Were Properly Billed
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Article Overview
This industry news piece reviews several Medicare compliance and enforcement topics of interest to healthcare coders, compliance teams, and providers. It covers an OIG audit involving evaluation and management billing with outpatient eye injections, Medicare guidance on payment for home health face-to-face documentation, and a Department of Justice case involving alleged kickbacks tied to patient referrals. The article is useful for readers tracking audit risk, documentation expectations, and fraud-and-abuse enforcement trends.
Why This Topic Matters
The article highlights areas where billing, documentation, and referral practices can trigger overpayment findings or enforcement scrutiny. It is relevant to organizations that bill Medicare, support home health certification processes, or manage compliance programs in specialties affected by medical review.
What You Will Learn
- How an OIG audit framed billing concerns around evaluation and management services associated with eye injections
- What Medicare-related guidance says about payment for home health face-to-face documentation
- Why alleged kickback arrangements involving patient referrals can create fraud-and-abuse exposure
- How these developments may affect compliance monitoring and billing review priorities
Who Should Read This
- Medical coders
- Billing and reimbursement staff
- Compliance officers
- Healthcare auditors
- Home health providers
- Physician practices
- Revenue cycle teams
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