Medicare billings with modifier GY. Modifier GY is used to code for services that are statutorily excluded or do not meet the definition of a covered service. Beneficiaries or their secondary insurance plans are responsible for paying these charges. Citing the more than 75 million claims (totaling $820 million) that Medicare received in FY 2008 with a modifier GY, the OIG says it will look for patterns and trends in how physicians and suppliers are using the modifier.
9. Audit aversion
Audits help uncover gaps between what you document and what you code, which is one reason why the Department of Health and Human Services Office of Inspector General recommends regular chart audits. Yet many practices neglect auditing, says Cindy Dunn, a consultant with MGMA Health Care Consulting Group.
"Even when a practice does these audits, I don't always see them done well, nor do I see them doing anything to follow up, which means they'll just keep repeating their mistakes," Dunn says.
She suggests that each year, you review at least five notes for each of your government payers, or 10 notes selected at random. Make sure to conduct audits for each physician and make sure each of your practice sites is represented. A basic audit compares documentation with the codes submitted on the claim form. Look for discrepancies and study up on where you find weakness.
Coders like Vaught suggest using the data to make a simple graph showing, for example, how many level 3 and 4, new and established patients you are coding compared with the national average of Medicare data for your specialty.
Want to get your practice partner's attention to take audit findings seriously? Try extrapolating the results of your small-scale audit to a full year of income lost by undercoding or gained inappropriately by overcoding. After all, that's similar to the way the feds figure fines for overcoding.
Robert Redling is a freelance writer based in Tacoma, Wash. He has been practice management editor for Physicians Practice, Web content editor and senior writer for the Medical Group Management Association, and a speechwriter for the American Academy of Family Physicians. He can be reached via [email protected].
This article originally appeared in the May 2010 issue of Physicians Practice.