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Rev Cycle Documentation Errors Add Up to Almost $5M, OIG Says

Analysis  |  By Amanda Norris  
   December 29, 2022

The OIG found that incorrect modifier usage led to $4.9 million in overpayments.

Now is the time to shore up your revenue cycle as some providers may need to pay for incorrect modifier usage.

According to the recent report by the OIG investigating instances of incorrect co-surgery and assistant-at-surgery modifier usage, 69 of 100 sampled procedural services did not meet federal requirements.

An additional review of 127 corresponding services found that 49% were noncompliant with federal requirements, as well.

The OIG reviewed a randomly selected sample of 100 services rendered by Part B providers between 2017 and 2019 with certain CPT procedural codes and a Medicare Physician Fee Schedule (MPFS) co-surgery indicator of 1 or 2. The reviewed procedures included spinal fusions, knee replacements, and endovascular repairs, among others.

Having an MPFS co-surgery indicator of 1 means co-surgeons could be paid, though supporting documentation is required to establish medical necessity for a two-surgeon procedure. Having an MPFS co-surgery indicator of 2 means co-surgeons are permitted and no documentation is required if the two-specialty requirement is met.

According to the report:

  • 49 of the sampled services (71%) were reported without the co-surgery modifier
  • 14 of the sampled services (20%) were reported without an assistant-at-surgery modifier
  • 6 of the sampled services (9%) were duplicate services

The OIG estimates that the errors resulted in a total of $4.9 million in overpayments during the audit period.

 

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.

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