APR 04, 2018
Audit Watch: What to Do if You’re a Palmetto Outlier
Medicare administrative contractor Palmetto has recently sent comparative billing reports to practices in North Carolina, South Carolina, Virginia and West Virginia. If you received a letter indicating you are an outlier in certain areas, Palmetto wants you to submit additional information.
Palmetto is looking at:
- E&M or Eye visit code exams; and
- Cataract or complex cataract surgery.
If you are an outlier, you need to send Palmetto responses to the following five questions:
- Is there documentation present for all dates of service billed and/or operative eye billed?
- Is patient’s own assessment of functional status causing him/her to seek medical attention?
- Is there evidence of a comprehensive eye examination and ocular examination and a single diagnostic A-scan to determine the appropriate lens?
- Is there documentation indicating that the cataract is significantly contributing to the patient’s visual impairment in the presence of one or more concomitant ocular diseases?
- What are your self-auditing methods?
Ophthalmology practices face audits more frequently than ever. Your best defense against audit triggers and costly penalties remains the Academy’s advanced coding resources. These include: