Medicare audit due to any areas of concern by Medicare. (cont.)

Examples:

  • GP has provided services to more than 80 patients on 20 days over 12 months period – this is a 100% guarantee of Medicare audit.
  • GP consistently provides services to close to 80 patients a day or more – highly likely to get audited.
  • GP bills an unusually high number of items 36 and 44 compared to item 23.
  • GP bills some ‘favourite’ number significantly more often than other GPs e.g. ABI Doppler 11610, ECG, one particular surgical item.
  • GP consistently bills multiple items per attendance as ‘unrelated’. E.g. 36 +2713, 23+2717. 
  • The sum of the time for the items billed in one day is beyond the reasonable working day. E.g. the sum of the time for items billed is more than 12 – 14 hours in one given day.

BACK NEXT

Categories: Uncategorized