In a CMS review of 100 sample services in 2007, physicians incorrectly coded place-of-service 90 times, wrote Paul Weygandt, MD, JD, vice president of physician services for J.A. Thomas & Associates.
The place-of-service code provides physicians who perform a procedure in their offices a higher payment than a physician who did the procedure in the hospital or ASC, which are paid a facility fee in addition to the physician payment. The extra amount recognizes the extra practice expenses in the non-facility location.
“By misidentifying the place of service as non-facility, physicians in essence are double-charging Medicare for practice expenses for which the facility already is being compensated,” Dr. Weygandt wrote.
He provided an example of incorrect billing by a pain management physician. A carrier paid a physician $374 for performing a spinal pain injection procedure coded as having been performed in his office.
“Our analysis showed that the physician actually performed this procedure in a hospital outpatient department and that a fiscal intermediary had reimbursed the hospital for the overhead portion of the service,” Dr. Weygandt wrote. “If the claim had been coded correctly, the physician would have received a payment of $96, which would not have included overhead costs.”
Read the RAC Monitor report on place-of-service coding.
Read more coverage of RACs.
– RAC Denials Based on Incorrect Dosages: Q&A With Elizabeth Lamkin
– As Denials Rise, Hospitals Working Harder to Fend Off RACs
