DEC 05, 2022
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:
The Academy continues to provide education and resources to help audit-proof your documentation so no outside source can recoup.Cataract Documentation ChecklistAuditproof Your Evaluations for Cataract SurgeryVideo: Intravitreal Injection Documentation ChecklistIntravitreal Injection Documentation Checklist (PDF)