Information for Medical Providers

THINGS TO LOOK OUT FOR• Providers ALWAYS asking for the same

employee.

• Coworkers making too many photocopies or printouts.

• Unusual data queries.

HOW TO PROTECT YOURSELF

• Stay current with all HHS Bulletins• Document questions/answers to/from

Medicare Contractors Self audits• Self audits• Report billing errors/overpayments to your

contractors

HOW TO PROTECT YOURSELF:

COMPLIANCE PLAN

• Identify a Compliance Officer (CO)• Fund/support the CO• Identify/address high risk areas• Open lines of communication with CO• Employee hotline• Screen employees• Train billing clerks and other.

Practical Tips

For protectingyour practice

Protect your PIN

• Use the ‘need to know’ rule.

• Revoke reassignments or agreements promptly and in writing.

Your Employees

• Screen new employees carefully.

• Develop procedures to minimize risk.

Your Employees

• Carefully delegate signing authority.

• Conduct periodic checks of sensitive procedures.

Billing Services

• Check references.

• Get copies of all correspondence.

• Ask for reports showing claims billed.

Review the Medicare Reviews

• Implement changes in billing procedures.

• Attend billing workshops conducted by Medicare’s Provider Education Team.

Payments Made in Error

• Return the money to Medicare within 30 days.

- Do not keep incorrect payments.

When Medicare Calls…

• Comply with requests for medical records, etc.

• Take every request seriously.

• Respond in a timely manner.

CHIROPRACTIC FRAUD SCHEMES

• Upcoding• Double billing• Circumventing defined benefits• Ping Ponging (intra-referral pattern)• Unbundling• Code stuffing• Billing under a Medical Doctor’s UPIN