Highmark Post Payment Audit Reveals 73% Error Rate

September 21st, 2010

A recent audit performed by Highmark Medicare Services discovered that incorrect billing of procedure codes 99204 and 99205 occurred in 73% of records reviewed.  The issues include the following:  1) Incorrectly coding the level of service, 2) Lack of an accepted form of provider signature, 3) Incident to guidelines not supported by documentation, 4) Documentation does not support services billed.
 
Result:  An edit on procedure codes 99204 and 99205 will be put into action for providers in all specialties requiring written documentation to support the level billed.
 
You can find the full bulletin here:  www.highmarkmedicareservices.com/bulletins/partb/news09202010.html