OIG Auditors Focus On Billing for Ophthalmology Services

One more reason to button up your eye care practice’s coding and billing: The HHS Office of Inspector General has vowed to keep a close eye on ophthalmology claims, and the watchdog agency is urging CMS to do the same.

“Our work identifies improper payments, which sometimes may be caused by fraud, but may also indicate questionable billing patterns that could lead to waste or signal other problems, such as low quality of care,” said Inspector General Daniel R. Levinson in the OIG’s Semiannual Report to Congress, released on Nov. 30.

The report recommends that CMS monitor ophthalmology billing and take action against those ophthalmologists who are found to be billing inappropriately. In 2012, Medicare Part B made $171 million in questionable payments to the four percent of providers that appeared to be billing inappropriately. Among these 1,726 providers were claims for medically unnecessary services or even visits that never actually happened.

Any amount over $3 billion may sound like an enormous number in terms of Medicare billings, but that’s the amount the OIG recovered in fiscal year 2015 alone, observes Torrey Kim of Part B Insider. The agency recorded audit receivables of $1.13 billion, another $2.22 billion in investigative recoveries and $286 million from other sources for a grand total of $3.35 billion.

Let’s Connect

Drop a line for our sales representative to get in touch with you

  • This field is for validation purposes and should be left unchanged.

Latest Article

images

CMS Releases the 2022 QPP Proposed Rule – Here’s What You Need to Know

  • 03 Sep 2021

On July 13, 2021, CMS released its Quality Payment Program’s 2022 Proposed Rule, and while it is increasingly clear that CMS intends to move forward with their plan to eventually replace traditiona...

images

Your Complete Guide to Patient No-Shows

  • 29 Jun 2021

How much are cancelled appointments and no-shows costing you? Nothing is worse than being stood up — especially when it affects your bottom line. Patient no-shows are a longs...

images

What Scheduling Strategy is Right For Your Practice? 3 Options

  • 28 Jun 2021

3 Options That Decrease Wait Times, Shorten Turnaround, and Maximize Efficiency In today’s competitive climate, many doctors are content to have a steady stream of patients each...

test
test