tci Part B Insider - 2007 Issue 20

TRANSMITTAL ROUNDUP: Medicare Could Auto-Deny 100 Percent Of Suspicious Claims

Make sure each NPI matches up to only one UPINWatch out: Medicare's Program Safeguard Contractors (PSCs) will be on the lookout for -high-risk areas- soon. These are groups of claims with unusual patterns that show a potential for fraud and abuse. Warning signs could include: - a sudden change in billings, - a spike in billings, - the wrong specialty billing for some procedures, - the wrong diagnosis codes on claims, - beneficiary complaints, or - billing for bundled Part B services during a Part A institutional stay. Red flag: Another big warning sign would be a doctor ordering...

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