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Keeping with the Code: Medicare Reimbursement Starts with Drug Coding Compliance

First few Article Sentences

Given the scale and complexity of the Medicare system, outpatient drug billing can be complicated. Incomplete medical records, errors in drug dosage reporting, and a lack of attention to the nuances of the Healthcare Common Procedure Coding System (HCPCS) are just a few factors that contribute to incorrect claims—particularly for outpatient drugs.

In 2014 the Office of Inspector General (OIG), housed within the Department of Health and Human Services, will review Medicare outpatient drug claims to identify incorrect coding and overbilling. This month the OIG is expected to set forth a work plan detailing the projects to be audited and addressed within the fiscal year.

To prepare for the upcoming audits and avoid the consequences and penalties associated with incorrect billing and overpayments, providers should improve their understanding of the billing guidelines and establish an internal auditing process for complying with the requirements set forth by the Centers for Medicare & Medicaid Services (CMS).

Amstutz, MBA, CCS, CCS-P, Peggi Ann


Moss Adams LLP


February 11, 2014

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