News| Volume 16, ISSUE 9, P20, September 2015

Coding Errors Cost Millions in Overpayments

      Coding mistakes made on behalf of physicians and other health providers led to more than $35 million in Medicare overpayments for outpatient drugs, according to results from an audit by the Department of Health & Human Services Office of Inspector General (OIG).
      Medicare contractors in 13 jurisdictions overpaid Medicare Part B providers by $35.8 million between July 2009 and June 2012. Erroneous codes and incorrect units of service submitted on behalf of those providers were the top reasons for the overpayments, according to the OIG report.
      The medications most frequently overpaid because of incorrect units of service were adenosine, rituximab, infliximab, leuprolide acetate, and bortezomib.
      Other common billing mistakes by physicians that resulted in overpayments included insufficient documentation about patient services; billing for outpatient drugs in which payment was already included in that of a primary procedure; incorrect use of Healthcare Common Procedure Coding System codes; and billing Medicare for noncovered outpatient drugs. As of May 4, the Centers for Medicare & Medicaid Services had recovered 63% of the overpayments found in the OIG audit, according to the report.
      Alicia Gallegos is a Frontline Medical News freelance writer based in Chicago.