Physician RAC Vulnerabilities Detailed in CMS Release
Continuing its efforts to publicize valuable information derived from the RAC demonstration, CMS released on December 2 the fourth in a series of MLN Matters articles.
The latest, Special Edition article SE1036, provides education on two high-risk vulnerabilities for physician claims. According to CMS, these claims were denied because the demonstration RACs determined that either a duplicate claim was billed and paid, or the physician reported an incorrect number of units for current procedural terminology (CPT) code billed based on the CPT code descriptor, reporting instructions in the CPT book, and/or other CMS local or national policy. Examples include:
Other services with excessive units—Units billed exceeded the number of units per day based on the CPT code descriptor, reporting instructions in the CPT book, and/or other CMS local or national policy. (Pre-appeal improper payment amount: $6,635,558)
Duplicate Claims—Physician billed and was paid for two claims for the same beneficiary, for the same date of service, same CPT code, and same physician. (Pre-appeal improper payment amount: $1,094,751
- Antibiotic Overuse a 'Huge Threat' to Patient Safety, Says CDC
- CFO Exchange: Smartphones Poised to Disrupt Healthcare, Says Topol
- Consumerism Drives Healthcare Branding, Rebranding Efforts
- 3 Traits Personality Assessments Can't Reveal
- PA Ranks See 'Phenomenal Growth,' Lack of Diversity
- CHS Hacked, 4.5M Patient Records Compromised
- CFO Exchange: Healthcare Leaders Share 5 Innovative Ideas
- Business Roundup: M&A Activity Down Slightly in First Half of 2014
- CNO on Hospital Redesign: 'You Can't Over-Communicate'
- Large Employers Trimming Healthcare Spending