Tailored Medicare Billing Compliance Policies and Procedures

Providers that bill Medicare for cardiovascular stress testing must follow custom-tailored billing compliance policies and procedures. These policies and procedures must address all pertinent rules and regulations, and they must do so in a way that facilitates compliance within the context of their unique operations. Too often, health care providers rely on off-the-shelf compliance programs purchased from vendors, and in doing so they fail to address the specific risks they face on a day-to-day basis.

If a provider’s Medicare billing compliance policies and procedures do not address the provider’s specific risks, then they are not going to serve their intended purpose. This is particularly true with regard to nuanced areas of compliance such as cardiovascular stress testing. Providers will make mistakes, and they will face adverse consequences as a result.

As mentioned above, maintaining adequate documentation is critical for demonstrating compliance in the event of a Medicare audit or billing fraud investigation. With regard to cardiovascular stress testing, documentation of medical necessity is particularly important. In order to avoid allegations of fraudulently billing Medicare for excessive and unnecessary tests, providers must be able to demonstrate (with documentation) that they have affirmatively considered the eligibility criteria for these tests. Even if a cardiovascular stress test is eligible based on the reason for which it was conducted, if a provider cannot substantiate this reasoning, it could still face liability for recoupments and other penalties.

For more information click here https://www.jdsupra.com/legalnews/federal-authorities-place-8579972/