Anesthesia & Pain Management Compliance Auditors

ACE Alerts

Keeping You Up-To-Date on the News You Need to Know
21
Nov

ACE ALERT 10/14/2019

Case Settlement reinforces the importance of medical direction documentation.

The US Department of Justice in the Western District of Michigan announced last Thursday that a settlement had been reached regarding claims billed as medically directed anesthesia services that did not meet the regulatory requirements and conditions of payment for billing those services as medically directed.  The settlement, $607,966,  is a harsh reminder to anesthesia groups that not only is medical direction documentation important but reviewing it before assigning claims modifiers should be an essential step in the coding and billing process. 

Reference to the case can be found at https://www.justice.gov/usao-wdmi/pr/2019_1010_Traverse%20Anesthesia%20Associates.  (United States, et al. ex rel. Stone, et al., v. Traverse Anesthesia Associates, P.C., et al., No. 1:18-cv-1416 (W.D. Mich.).


This is a good time for groups to review their policies regarding the documentation of the seven steps of medical direction and do a focused audit regarding those steps.  If we can be of any assistance to you or your group in helping with your compliance or coding, please feel free to contact us.