tci Part B Insider - 2015 Issue 1

Physician Notes: Ever Feel Like Auditors Are on A Witch Hunt? CMS Responds

If you get frustrated over auditors’ reviews of your claims, you aren’t alone. A caller to CMS’s Jan. 7 Open Door Forum questioned whether CMS is just performing fishing expeditions, finding practices guilty until proven innocent—and one CMS official explained why. “Observation management codes, if they’reless than eight hours, they don’t count,” the caller said. Auditors, however, have no idea about whether submitted observation care codes reflect services performed for less than eight hours or not until they receive the practices’ paperwork. “We always give the information and it’s always...

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