OIG Auditors Focus On Billing for Ophthalmology Services

dollar bill

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

Building a Culture of Patient Safety with Eye Care Leaders

  • 12 Nov 2020

You might be a patient’s ophthalmologist, but it’s highly unlikely that you’re the only provider he or she is seeing. Patients often consult several providers at the same time, and every provider m...

3 Ways Healthcare Technology is Facilitating Integrated Care

  • 12 Oct 2020

[vc_row][vc_column][vc_column_text]The recent shift to value-based care is forcing healthcare practices to improve care quality and efficiency while cutting costs. Indeed a daunting task, but lever...

4 Reasons Eye Care Practices Switch EHR Software

  • 01 Oct 2020

[vc_row][vc_column][vc_column_text]Many factors are involved when an eye care practice decides to switch electronic health record (EHR) software. Some of the potential reasons that lead to switchin...