Outpatient Facility Coding Alert - 2014 Issue 36
Compliance: 3 Lessons You Can Learn From These Medicaid Audits
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Article Overview
This article summarizes lessons drawn from recent Medicaid audit findings and explains why they matter for physicians and billing staff. It focuses on broad compliance themes such as office versus facility billing, Medicaid EHR incentive program eligibility, and place of service reporting in outpatient and emergency room settings. The piece is useful for practices that want to understand common audit risk areas and review the general categories of documentation and billing issues that can trigger repayment or compliance problems.
Why This Topic Matters
Medicaid audits can identify billing and documentation mismatches that lead to repayment and other compliance concerns. Understanding the general risk areas covered here can help practices review internal processes before similar issues appear in an audit.
Article Sections
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Introduction
An overview of Medicaid audits and the general compliance concerns they raise for physician practices.
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Billed amounts exceeded global fees in the outpatient clinic
Discussion of a Medicaid audit finding related to hospital outpatient clinic billing and the broader issue of facility-versus-office payment differences.
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Collecting EHR incentives without meeting the requirements
Summary of audit findings involving Medicaid EHR incentive eligibility and patient volume requirements.
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Billing amount exceeded limits in the emergency room
Discussion of audit findings related to emergency room place of service reporting and hospital-based billing compliance.
What You Will Learn
- How Medicaid audits commonly identify billing and documentation problems.
- What broad compliance areas are highlighted by recent audit results.
- How place of service reporting can affect hospital-based claims.
- Why EHR incentive program eligibility is an audit focus.
- Which general types of issues may lead to Medicaid repayment findings.
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance officers
- Practice managers
Codes Discussed
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