A recent report by the HHS' Office of Inspector General found that in 2007, Medicare overpaid physicians by an estimated $13.8 million due to incorrect site-of-service codes attached to claims.
Physicians receive site-of-service differentials as part of their payment for services. Physicians receive higher payments for procedures performed in the office as opposed to hospitals or surgery centers, because Medicare is not billed a separate facility fee for in-office procedures.
The OIG's audit, which is detailed in the report, examined a sample of 100 of the 484,218 nonfacility-coded physician services valued at $42,385,710 that were provided in 2007 and that matched hospital outpatient or ASC claims for the same type of service provided to the same beneficiary on the same day. Of the 100 Part B claims examined, 90 of them were actually performed at hospital outpatient departments or ASCs and were incorrectly coded as in-office procedures.
The OIG recommends that CMS examine the additional 484,118 claims that were not part of the sample and move to recover all overpayments.
Read the OIG report on site-of-service overpayments.
Physicians receive site-of-service differentials as part of their payment for services. Physicians receive higher payments for procedures performed in the office as opposed to hospitals or surgery centers, because Medicare is not billed a separate facility fee for in-office procedures.
The OIG's audit, which is detailed in the report, examined a sample of 100 of the 484,218 nonfacility-coded physician services valued at $42,385,710 that were provided in 2007 and that matched hospital outpatient or ASC claims for the same type of service provided to the same beneficiary on the same day. Of the 100 Part B claims examined, 90 of them were actually performed at hospital outpatient departments or ASCs and were incorrectly coded as in-office procedures.
The OIG recommends that CMS examine the additional 484,118 claims that were not part of the sample and move to recover all overpayments.
Read the OIG report on site-of-service overpayments.