Could you pass this test on billing errors?
Could you pass this test on billing errors?
HCFA lists common claims oversights
As the list of potential red-flag items on claim submissions grows longer and longer, it is important to keep track of some common problem areas among physician offices. HCFA's Office of Billing Audits provided Physician's Payment Update with a list of these common claim problems and errors:
1. Evaluation and Management Services. Providers frequently misuse CPT codes, resulting in overcoding and incorrectly assigned codes. Auditors often find there is not enough chart documentation to back up the use of higher-level codes.
2. No match between billed diagnoses and diagnoses contained in the medical chart. Even if it's just a computer glitch, it's still a red flag for federal fraud cops - and a potential audit. HCFA recommends the patient's diagnoses be constantly updated in your billing records to match the current date of service. Also, make sure each patient's HCFA 1500 or electronic data file matches the medical chart for each date of service billed.
3. Truncated ICD-9-CM codes. Providers often "truncate" or fail to carry out a diagnosis code to its most specific level.
4. "Rule Out" assessments coded as confirmed diagnoses. It is common for coding clerks to fail to code the signs and/or symptoms the patient presented, and instead code the suspected condition when assigning ICD-9-CM codes for "rule out," "probable," and "suspected" diagnoses or diagnostic differentials.
5. Interchanging CPT code 99211 with code 99212. Coding a 99212 (established patient office or other outpatient visit) to a 99211 code is one of the things auditors automatically look for - and often ask about - during a billing audit.
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