Avoid Bad Dreams & Bad Billing - OIG to Audit Sleep Study Services

  • Cindy Gallee, JD, RHIA, CHC
  • Aug 11, 2015
  • Comments

Polysomnography services, or sleep studies, are prone to errors in billing and need to be carefully monitored by payers. Sleep study billing is significantly mentioned as an audit topic in the OIG Work Plan for 2015 and using this plan, a recent OIG report 1 found deficiencies in the payment of sleep study services by a Medicare Administrative Contractor. At issue in this report were duplicate billing of sleep study services and inadequate provider documentation. A sleep study is ...

New Legal Team to Enforce OIG Industry Guidance to Help Stop Fraud

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

Detecting fraud, waste and abuse has become more important than ever with the U.S. Department of Health and Human Services Office of Inspector General (OIG) recently announcing a new legal team dedicated to the enforcement effort. This team will enforce OIG industry guidance by affirmatively litigating against providers who commit fraud through the use of civil monetary penalties and exclusion from federal health care programs. According to Lisa Re, the Chief of the Civil Remedies ...

Context & AXA Assistance USA Announce the Successful Implementation of FirstPass™ and the New Real-Time UCR Fee Retrieval

  • Kate Armbruster
  • Jul 07, 2015
  • Comments

Context 4 Healthcare, Inc . , a leading provider of healthcare compliance and reimbursement solutions, and AXA Assistance USA, the world leader in providing assistance, announce today the successful implementation of Context’s FirstPass™ claim editing solution within AXA’s benefit claim management workflow. The implementation included Context’s DecisionPoint™ UCR fee schedule integrated with FirstPass™ to provide unprecedented real-time access to usual, custo ...

ICD-10 Testing & Training Procrastination: 98 Days Until the Deadline

  • Margaret Klasa DC, APN BC
  • Jun 25, 2015
  • Comments

Do you ever have that nightmare where you are back at school, sweating at your locker trying to find your school books to study for the test that is coming up in minutes and then the bell rings and you wake up? Providers, are you having that nightmare now about the ICD-10 code transition? Are you secretly deep down inside crossing your fingers that there will be a delay or some type of miracle at the last minute so that you don’t have to worry about it? Well, unfortunately, even with a c ...

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 ...

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