Continuing its efforts to publicize valuable information derived from the RAC demonstration project, CMS released on December 2nd the fourth in a series of MLN Matters articles.
The latest, Special Edition article SE1036, provides education on two high-risk vulnerabilities for physician claims. According to CMS, claims were denied because the demonstration RACs determined that either a duplicate claim was billed and paid, or the physician reported an incorrect number of units for CPT codes billed based on the CPT code descriptor, reporting instructions in the CPT book, and/or other CMS local or national policy.
These RAC findings highlight the importance of the accuracy of the CPT code descriptions used in physician's charge documents (superbills), and should also discourage physicians from submitting charges repeatedly "just to be sure they weren't missed the first time."
Click here to read the entire MLN article.