Corporate Compliance

Other developments: OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical Center, issues report on claim modifier ?KX, and more

Medicare Update for Physician Services, May 3, 2012

OIG issues review of Medicare outpatient billing for selected drugs at Catskill Regional Medical Center

The OIG reviewed Medicare payments made to Catskill Regional Medical Center, located in Harris, NY, for line items for injections of selected drugs that the hospital billed to Medicare from January 1, 2008 through April 30, 2011. The OIG showed that Catskill received overpayments totaling $78,000 due to the following errors: 

  • For five line items, Catskill billed the incorrect number of units of service
  • For two line items, Catskill used the incorrect HCPCS code
  • For one line item, Catskill billed for a drug that was not administered

View the report

OIG issues report on claim modifier –KX

On April 20, the OIG issued a report on the –KX modifier, which indicates that a claim meets Medicare coverage criteria and the supplier has the required documentation on file. The report found that the modifier is not effective in ensuring that suppliers of DMEPOS that submitted Medicare claims had the required supporting documentation on file and the OIG estimates that contractors paid approximately $316.4 million to suppliers that did not have the required documentation on file to support the DMEPOS items with 2007 dates of service.

View the OIG report.

CMS issues minor edits to ABN instructions form

On April 19, CMS issued an update stating that minor edits have been made in the ABN instructions to clarify that the provider/supplier is responsible for inserting wording in all of the blanks labeled “D” on the notice including the “D” blanks that are within the “Options” section.  Please click the link in the list below to download the updated ABN instructions.

View the updated instructions.

CMS issues April 2012 Medicare NCD Coding Policy Manual and Change Report

On April 27, CMS issued the Medicare national coverage determinations (NCD) Coding Policy and Manual Change Report for clinical diagnostic laboratory services for April 2012.

View the report.

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