EW SHOW DAILY
50
ASCRS Symposia
Monday, May 8, 2017
by Vanessa Caceres EyeWorld Contributing Writer
of Physicians and Staff," William
Koch, COE, Dallas, said compliance
issues are less of a gap and more of a
silo between physicians and practice
management staff, as each group I
s your practice doing enough to
address compliance with gov-
ernment regulations regarding
billing? In Sunday's sympo-
sium "Compliance: The Role
focuses on different issues. The
session aimed to address blind spots
that both physicians and practice
administrators may have.
John Kung, MD, Staten Island,
New York, and East Brunswick, New
Jersey, shared information about
the federal government's increased
efforts to zero in on questionable
Medicare billing within ophthal-
mology. Their reason for this focus
is based largely on a 2015 Office of
Inspector General (OIG) report that
tracked Medicare billing for wet
age-related macular degeneration
(AMD) and cataracts and found that
4% of the claims filed had ques-
tionable billing. Some examples of
the latter included more than one
ranibizumab (Lucentis, Genentech,
South San Francisco) injection per
28 days, unusually high percentages
of complex cataract surgeries, and
more than three annual fluorescein
angiographies or ICG angiographies.
The OIG report recommended
increased scrutiny of billing for wet
AMD and cataract procedures and
more unannounced visits to prac-
tices.
Dr. Kung advised practices
to develop thorough compliance
programs that focus on coding and
billing errors—such as double billing
and upcoding—and documentation.
Within documentation, one area
practices should check for is provid-
ing reasons, findings, and assess-
ments for diagnostic tests, Dr. Kong
said. This is a common pitfall.
Practices also should make sure
to have compliance programs with
written policies on compliance
expectations, a person who oversees
compliance on a day-to-day basis,
self-audits, and clear methods of
discipline for non-compliance, said
Gerald D'Aversa, MD, whose prac-
tice has 36 doctors and 13 offices on
Long Island. It's also important that
there is a policy of non-intimidation
and non-retaliation so employees
are not afraid to report possible
billing and compliance concerns, he
said.
When selecting a compliance
officer, practices should hone in on
someone who is knowledgeable, has
good communication skills, and is
approachable and diplomatically
persuasive. "In a small practice, out-
sourcing this role is not unreason-
Session addresses
thorny issue
Is your practice in compliance with
government billing regulations?
continued on page 52
