Audit finds coding errors common

September 10, 2010

Physicians often code for the wrong place of service when submitting payment claims to Medicare, resulting in widespread overpayments, according to HHS.

Physicians often code for the wrong place of service when submitting payment claims to Medicare, resulting in widespread overpayments, according to the Department of Health and Human Services' Office of Inspector General (OIG).

OIG randomly sampled 100 paid services performed in 2007, and analyzed the medical and billing records of 97 physicians who provided the services, as well as answers to questionnaires sent to the doctors. It found that for 90 of the services, non-facility place-of-service codes were used for services performed in ambulatory surgical centers or hospital outpatient departments.

OIG estimates Medicare overpaid nationwide for about 484,000 similar services by more than $13.7 million, and recommends that the Centers for Medicare and Medicaid Services (CMS) reopen claims associated with those services. It is also urging CMS to reemphasize the importance of correctly coding the place of service.