Information for Medical Providers

THINGS TO LOOK OUT FOR Providers ALWAYS asking for the same employee. Coworkers making too many photocopies or printouts. Unusual data queries.

HOW TO PROTECT YOURSELF Stay current with all HHS Bulletins Document questions/answers to/from Medicare Contractors Self audits Self audits Report billing errors/overpayments to your contractors

HOW TO PROTECT YOURSELF: COMPLIANCE PLAN Identify a Compliance Officer (CO) Fund/support the CO Identify/address high risk areas Open lines of communication with CO Employee hotline Screen employees Train billing clerks and other.

Practical Tips For protecting your practice

Protect your PIN Use the ‘need to know’ rule. Revoke reassignments or agreements promptly and in writing.

Your Employees Screen new employees carefully. Develop procedures to minimize risk.

Your Employees Carefully delegate signing authority. Conduct periodic checks of sensitive procedures.

Billing Services Check references. Get copies of all correspondence. Ask for reports showing claims billed.

Review the Medicare Reviews Implement changes in billing procedures. Attend billing workshops conducted by Medicare’s Provider Education Team.

Payments Made in Error Return the money to Medicare within 30 days. - Do not keep incorrect payments.

When Medicare Calls… Comply with requests for medical records, etc. Take every request seriously. Respond in a timely manner.

CHIROPRACTIC FRAUD SCHEMES Upcoding Double billing Circumventing defined benefits Ping Ponging (intra-referral pattern) Unbundling Code stuffing Billing under a Medical Doctor’s UPIN