News: Almost $5M in revenue cycle documentation errors, according to OIG

CDI Strategies - Volume 17, Issue 3

In a recent report by the OIG, incorrect modifier usage led to an estimated $4.9 million in overpayments from 2017 to 2019. While investigating instances of incorrect co-surgery and assistant-at-surgery modifier usage, their audit found that 69 of 100 sampled procedural services did not meet federal services. With this in mind, now may be the time for organizations to shore up their revenue cycle as some providers might need to pay for incorrect modifier usage, HealthLeaders said in their coverage of the report.

The OIG sampled 100 randomly-selected services rendered by Part B providers with certain CPT procedural codes, reviewing procedures such as spinal fusions, knee replacements, and endovascular repairs. They also chose samples with a Medicare Physician Fee Schedule (MPFS) co-surgery indicator of 1 or 2.

Having an MPFS co-surgery indicator of 1 meant that co-surgeons could be paid as long as supporting documentation established medical necessity for a two-surgeon procedure. Having an MPFS co-surgery indicator of 2 meant that co-surgeons are permitted without documentation if the two-specialty requirement was met. Of the sampled services, the OIG found that 71% were reported without the co-surgery modifier, 20% were reported without an assistant-at-surgery modifier, and 9% were duplicate services, totaling in $4.9 million worth of overpayments during the audit period.

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the OIG report, click here.

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Denials & Appeals, Clinical & Coding, News