Outpatient Facility Coding Alert - 2005 Issue 27
PHYSICIAN NOTES: Medicare 'Bounty Hunters' Haven't Targeted Physicians-Yet
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Article Overview
This article summarizes several Medicare-related developments affecting physicians and other providers, including the early status of Recovery Audit Contractors, a CMS billing edit update, a state-level anesthesia supervision ruling, a physician fraud case, and a new Medicare appeals hearing structure. It is relevant to physicians, practice managers, compliance staff, and coders who track federal oversight and operational changes affecting claims and appeals.
Why This Topic Matters
The article highlights several operational and compliance issues that can affect physician practices, from audit exposure and claim edits to supervision requirements and Medicare appeals logistics. It helps readers monitor policy and enforcement developments that may influence documentation, billing workflows, and regulatory risk.
Article Sections
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Medicare audit activity and physician scrutiny
Discusses early Recovery Audit Contractor activity and the status of physician claims review in selected states. It also notes how CMS staff are tracking the issue.
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Medicare multiple surgery indicator update
Addresses a CMS policy issue involving the multiple surgery indicator applied to endovenous ablation procedures. The section references related add-on code status and follow-up with CMS staff.
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Other Medicare and regulatory updates
Summarizes additional items including smoking cessation counseling session edits, a state supreme court ruling on nurse anesthetist supervision, a physician enforcement case, and a new Medicare hearings office.
What You Will Learn
- How Medicare audit activity was being monitored at the time
- Which types of billing and claim-processing updates CMS was directing carriers to implement
- What broader regulatory and enforcement issues were affecting physician practices and anesthesia supervision
- How Medicare appeals hearing operations were being reorganized
Who Should Read This
- Physicians
- Medical practice managers
- Certified professional coders
- Compliance officers
- Revenue cycle staff
- Anesthesia providers
Codes Discussed
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