Ophthalmology Services: Questionable Billing and Improper Payments

Submitted by Matthew.Gregor… on Mon, 11/04/2019 - 07:45
Title
Ophthalmology Services: Questionable Billing and Improper Payments
Date

The Office of the Inspector General (OIG) reports that Medicare is vulnerable to fraud, waste, and abuse for wet Age-related Macular Degeneration (wet AMD) and cataracts:

  • Administration of Lucentis injections for wet AMD more than once every 28 days (based on local coverage determinations)
  • Billing for a second cataract surgery on the same eye
  • Submitting disproportionately more claims for complex than standard cataract surgery

Review the following resources for proper claims coding, billing, and payment: