- A private insurance carrier sends an audit request letter to a rheumatology practice to review its infusion medical records for the past 30 dates of service. What information should the practice send to the carrier?
- Only the infusion notes
- The complete notes for the requested dates of service only
- The complete notes for the requested dates of service, in addition to all pertinent information to support medical necessity
- All of the above
- The Medicare Zone Program Integrity Contractor (ZPIC) randomly selects your practice to pull and review charts for an audit. What should your practice do?
- Tell them to make an appointment to come back another day when you are prepared
- Allow them to pull the charts and continue with daily work flow, seeing patients
- Allow them to pull the charts, but assign a staff person to shadow them and make copies of anything that is pulled for review and/or copy
- None of the above
- Your practice receives a letter from the Office of the Inspector General (OIG) with notification and information that it is performing an audit on your practice. What should you do upon receiving this letter?
- Comply with any requests in the letter
- Contact a healthcare attorney based on the content of letter
- Contact the ACR for assistance with an audit review
- All of the above
- Your practice obtains a prior authorization and receives approval of a drug for an infusion. A year later, the infusion claims are audited on the infusions that were approved. The audit results indicate all the infusion claims were found to be not medically necessary, and the payer states the practice owes an overpayment. Can this happen?
- Your practice purchases medication for infusions from a drug company that seems reputable. It is obtaining drugs from outside the U.S., but you are not aware of this. Can your practice be held liable?
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Explore This IssueJune 2019
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For questions or additional information on coding and documentation guidelines, contact Melesia Tillman, CPC-I, CPC, CRHC, CHA, via email at firstname.lastname@example.org or call 404-633-3777 x820.