Facility or Nonfacility? The Wrong POS Can Lead to Costly Overpayments

  • Cindy Gallee, JD, RHIA, CHC
  • May 15, 2015
  • Comments

Payers should have a focus on whether they are receiving the appropriate place of service codes on physician claims. In a recent study of physician claims from 2010 through 2012, the Office of Inspector General (OIG) found that incorrect “nonfacility” place of service appeared on physician claims that should have been coded as “facility” place of service.   These claims were for services that physicians performed in facility settings such as ambulatory surgery ...

Context to Exhibit at HCCA Compliance Institute - Lake Buena Vista, FL

  • Kate Armbruster
  • Apr 17, 2015
  • Comments

Context 4 Healthcare, Inc . will showcase its suite of compliance solutions for hospitals and providers at the HCCA Compliance Institute 2015 , being held at the Walt Disney World Swan and Dolphin Resort in Lake Buena Vista, FL, April 19—21. The annual Compliance Institute is the Healthcare Compliance Association’s (HCCA) largest event. Over the course of four days, attendees have the opportunity to attend a variety of sessions covering topics such as healt ...

Compliance Reports Identify 7 Billing Issues to Monitor for Fraud Risk

  • Cindy Gallee, JD, RHIA, CHC
  • Apr 08, 2015
  • Comments

In a significant compliance report by the Office of Inspector General (OIG), published in March 2015, a large Midwestern academic medical center was found to owe Medicare over $6 million, extrapolated from alleged billing errors in a sample taken for the years 2011 and 2012. OIG identifies seven billing issues as putting hospitals at risk for noncompliance, based on their review at this hospital and other facilities it has reviewed as part of its work plan for this year. It is imperative that p ...

To Avoid Potential Fraud, Payers Should Monitor the LEIE Regularly

  • Cindy Gallee, JD, RHIA, CHC
  • Apr 06, 2015
  • Comments

Payers, especially those with contracts involving federal payments, should be monitoring their providers’ statuses under the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE). The OIG, part of the U.S. Department of Health and Human Services (HHS), is at the forefront of efforts to fight fraud, waste, and abuse in Medicare, Medicaid, and 300 other HHS services. 1 The OIG maintains the LEIE, which is a list of all individuals and entities excluded from rece ...

Identify Potential Fraud for Home Health Trends in E/M, Outliers & POS

  • Cindy Gallee, JD, RHIA, CHC
  • Feb 27, 2015
  • Comments

Investigators have long considered Home Health claims to be rife with the potential for fraud. The daily news illustrates this point as fraud convictions of Home Health operators appear regularly. Last week, an owner of a Miami Home Health company pleaded guilty to a $13 million fraud, perpetuated by kickbacks and bribes to patients and medical providers for referrals and prescriptions that were used to fraudulently bill Medicare . 1 Data indicating fraud in home health claims has important imp ...

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