Correct coding is critical for oncologists to maximize reimbursement and mitigate risk of a Medicare audit. Oncology coding has become so complicated that most practices will experience an audit at some point.
In other areas of law, fraud is defined as the willful intent to deceive. Yet in healthcare, it is defined as a reckless disregard of the coding guidelines. Innocent mistakes are frequently audited and investigated as potential fraud. A simple mistake can result in a fine of up to $10,000.
It is imperative that practices have procedures in place to ensure their business office is billing within the federal guidelines. Simple, incorrect coding patterns may appear as reckless disregard and place the practice at risk of a Medicare audit.
Examples of incorrect coding patterns are:
- Billing for items included in the administration services
- Billing for saline for other than hydration
- Billing for flushing the line following administration
- Billing for heparin used to flush the line, standard tubing, syringes and supplies
These services bundle against the administration code but can be paid in error. Practices often continue to bill for these services because they have received payment in the past. However, this ultimately can result in further scrutiny from the Centers for Medicare & Medicaid Services (CMS), recoupment of the original payment and potential audits and penalties.
For help analyzing your practice’s revenue cycle, including billing and coding processes, and identifying your risk of a potential CMS audit, email email@example.com