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  • You Better Watch Out — Auditors Are Checking Their Lists Twice

    The Centers for Medicare & Medicaid Services (CMS) contracts with a Supplemental Medical Review Contractor (SMRC) and partnering Noridian as the national contractor, to help lower improper payment rates by conducting post-payment audits. 

    The two latest ophthalmology-specific SMRC audits were conducted on claims from Jan. 1, 2019 through Dec. 31, 2019 and focused on cataract surgery and intravitreal injection documentation. 

    The findings were not encouraging: Error rates for cataract surgery documentation were at 51% and 29% for intravitreal injections documentation. The top common reasons for claim denials are also disheartening: 
    • No response to the additional documentation request (ADR) was the No. 1 reason listed for both audits
    • Second was insufficient documentation. 
    • Signature requirements was the third deficiency for the cataract surgery findings and billing and coding is listed for intravitreal injections. 
    The Academy continues to provide education and resources to help audit-proof your documentation so no outside source can recoup.

    Cataract Documentation Checklist

    Auditproof Your Evaluations for Cataract Surgery

    Video: Intravitreal Injection Documentation Checklist

    Intravitreal Injection Documentation Checklist (PDF)