tci Part B Insider - 2015 Issue 19

Compliance: MACs to Seek Sleep Study Refunds in Wake of OIG Report

Medical records were sorely lacking in this audit. Your polysomnography documentation—or lack thereof—could be your calling card for attracting attention from auditors. On May 20, the OIG released a report detailing its audit of sleep study claims paid by Part B MAC First Coast Service Options. According to the agency, First Coast overpaid practices by a startling $15.7 million for sleep study claims between 2011 and 2012—and CMS wants that money back. It’s likely that other MACs will be scrutinized for sleep study payments as well, so be on the lookout for claim viability...

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