U.S. = Department of=20 Health and Human Services: Office of Inspector General

Skip=20 Navigation Increase Font=20 Size Decrease Font=20 Size

OIG Home 3D"Links Reports Office of Audit Services Center For Medicare and Medicaid = Services

Audit (A-01-08-00528)

06-17-2009
Review of Place-of-Service Coding for Physician = Services=20 Processed by Medicare Part B Carriers During Calendar Years 2005 and = 2006

Executive Summary

We estimated that carriers nationwide overpaid physicians $20.2 = million for=20 incorrectly coded services provided during the 2-year period that ended = December=20 31, 2006. The overpayments occurred because physicians did not always = correctly=20 code the office place of service on Medicare claims submitted to and = paid by=20 Part B carriers. For 129 of the 150 services that we sampled, physicians = incorrectly coded the claims by using the office place-of-service code = for=20 services that were actually performed in outpatient hospitals or = ambulatory=20 surgical centers, resulting in approximately $7,000 in overpayments. =

We recommended that the Centers for Medicare & Medicaid Services = (CMS)=20 instruct its Part B carriers to (1) recover the $7,000 in overpayments = for the=20 sampled services, (2) review our information on the 857,761 nonsampled = services=20 to identify services estimated at $20.2 million that were potentially = billed=20 with incorrect place-of-service codes and work with the physicians who = provided=20 the services to recover any overpayments, (3) strengthen their education = process=20 and reemphasize to physicians and their billing agents the importance of = correctly coding the place of service and the need for internal controls = to=20 prevent Medicare billings with incorrect place-of-service codes, and (4) = work=20 with fiscal intermediaries and program safeguard contractors to develop = a data=20 match that will identify physician services at high risk for = place-of-service=20 miscoding and recover any identified overpayments. CMS concurred with = our=20 recommendations and described the actions that it planned to take to = implement=20 them.

Complete Report

3DNotification=20 Download = the complete report (PDF)
Adobe=20 Acrobat Reader 3D"This is required = to view=20 PDF files. =

Copies can also be obtained by contacting the Office of Public = Affairs at=20 202-619-1343.

Report = Fraud |=20 Accessibility = | Privacy Notice | Disclaimers | Site Map

What's New | E-Mail List | Contact | Exclusions Database = | Guidance Practices =

HIPDB | HHS Internet | IGnet | USA.gov

U.S. = Department of=20 Health and Human Services: Office of Inspector General

Audit (A-01-08-00528)

06-17-2009Review of Place-of-Service Coding for Physician = Services=20 Processed by Medicare Part B Carriers During Calendar Years 2005 and = 2006

Executive Summary

Complete Report

06-17-2009
Review of Place-of-Service Coding for Physician = Services=20 Processed by Medicare Part B Carriers During Calendar Years 2005 and = 2006