If you get frustrated over auditors’ reviews of your claims, you aren’t alone. A caller to CMS’s Jan. 7 Open Door Forum questioned whether CMS is just performing fishing expeditions, finding practices guilty until proven innocent—and one CMS official explained why.
“Observation management codes, if they’re less than eight hours, they don’t count,” the caller said. Auditors, however, have no idea about whether submitted observation care codes reflect services performed for less than eight hours or not until they receive the practices’ paperwork. “We always give the information and it’s always legitimate and they keep asking for it, and it’s a real hassle to keep getting this information,” the caller said. “They just keep fishing for it…is that okay? Is that why we’re doing that? I thought we were just looking for the bad actors.”
“We are looking for the bad actors,” responded CMS’s William Rogers, MD, who acknowledged...
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