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If your
physicians are overseeing the care of home health patients,
you could find the carriers looking over your shoulder in
the wake of a new report.
Two
Texas physicians received $15,897 in wrongful reimbursement
for 236 care plan oversight (CPO) services on nine claims,
the HHS Office of Inspector General said in a new audit
report (A-06-04-00083). The physicians shouldn't have received
reimbursement for any of these services, because they didn't
actually provide 230 of them and lacked supporting documentation
for the remaining six, the OIG insisted.
Physicians
can bill for CPO (G0179-G0182) only once per patient per
month, the OIG notes. And physicians must spend at least
30 minutes on CPO to bill for the service. When these physicians
billed for those 236 services, Part B carrier Trailblazer
Health Enterprises didn't have edits in place to allow only
one CPO service per claim, but Trailblazer has added those
edits since then.
The
OIG recommended that Trailblazer examine more recent claims
to see if its edits are working, and educate physicians
on the requirements for CPO services. Trailblazer agreed
with both recommendations.
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