Over the previous yr I’ve noticed an growing variety of Medicare and Medicaid audits being initiated in opposition to psychologists and different psychological well being professionals.
I’ve just lately seen quite a few audits initiated in opposition to psychologists and psychological well being professionals who deal with assisted residing facility (ALF) and expert nursing facility (SNF) residents. Most frequently these are audits by the Medicare Administrative Contractor (MAC), as a result of this space of medical follow has been recognized as one fraught with fraud and abuse. Generally these are solely “probe” audits, preliminary audits requesting one (1) to 5 (5) medical information. Different occasions the MAC has been requesting anyplace from 120 to 375 information.
Zone Program Integrity Contracts (ZPICs), are the first Medicare fraud detection contractors. If a probe audit, MAC audit or different investigation of audit suspected fraudulent billing, the ZPIC could are available in. The ZPIC additionally identifies and goal varied CPT codes, areas of medical follow, providers and tools which are extremely prone to fraud. It’ll then provoke a ZPIC audit by itself. ZPICs obtain bonuses primarily based on quantities they recuperate for the Medicare program.
OIG Annual Work Plan.
The Workplace of Inspector Common (OIG) publishes a piece plan annually which discusses the areas, sorts of medical providers, CPT codes, tools and exams it considers to be most prone to fraud and abuse. The brand new plan is normally printed within the fall for the work yr. It’s accessible on-line.
Psychiatrists, psychologists and psychological well being counselors, in addition to facility directors, compliance officers, attorneys and billing and coding consultants ought to evaluate this work plan annually to be taught what the OIG considers to be fraud and abuse and why. Measures must be instantly carried out to treatment any issues in your follow or facility which are recognized.