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.