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Dear Medicare Partners: The following article was posted to our website today. We are asking for your assistance in disseminating this information to your associates. You may refer them directly to the article on the website at http://www.medicarenhic.com/providers/billing/emsrvoverpay_0505.htm
Evaluation and Management Services Overpayments - Multiple Services Same Day During a routine claims analysis, NHIC identified overpayments made to providers between October 2000 to November 2003. Our analysis identified multiple claim submissions of Evaluation and Management (E/M) services for the same patient, on the same date of service by the same rendering provider. According to Medicare regulations, only one Evaluation and Management service may be billed per day, per patient – (Publication 100-4, Chapter 12 §30.6 – Evaluation and Management Service Codes - General). In some instances, physicians may see a patient multiple times on a given day, or in multiple settings. Except in rare circumstances outlined in the above manual section, only the highest level of E/M service rendered on that date should be reported. For example, if a patient is examined in the office and later examined and admitted into the hospital, the physician would report the hospital admission as the E /M service rendered for that day. NHIC has implemented claims processing edits to eliminate these overpayments. NHIC is initiating an overpayment recovery process which will occur over the next several months to collect the overpaid funds. If you were one of the physicians identified, you will receive an overpayment letter detailing the claims involved, the overpayment recovery process, refund procedures and options, and your available appeal rights. For additional information on reporting and documenting E/M Services, please visit http://cms.hhs.gov/medlearn/emdoc.asp
Thank you for your assistance. Michele
Kelly |