Top 10 RAC/OIG Targets
Incident-to Errors
Place of Service Errors
E/M Billed During Global Period
Medical Necessity
Psychiatric Services
Social Worker Services in Facilities
Pharmaceutical Coding in Physician Offices
Stark Violations
Duplicate Billing
Debridement Coding
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Amper’s Healthcare Services Group
- Incident-to Errors
- PA’s & NP’s not following billing guidelines related to the physician’s presence in the office
- Place of Service Errors
- Physicians billing a place of service code for the physician’s office when services were performed in an ASC or outpatient facility for higher reimbursement
- E/M Billed During Global Period
- Utilizing modifier -24 when service should have been included in global surgical package
- Medical Necessity
- Documentation not supporting the level of service provided
- Psychiatric Services
- Overutilization of outpatient psychiatric services
- Social Worker Services in Facilities
- Providing services for inpatient hospital or skilled nursing facilities that cannot be billed under Part B
- Pharmaceutical Coding in Physician Offices
- Incorrect use of codes or units for injections
- Stark Violations
- Physicians referring patients to services that they or a family member have a financial interest
- Duplicate Billing
- Debridement Coding
- Errors in coding surgical debridement vs. active wound care management
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