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Audit (A-01-12-00519)

07-05-2013
Wing Memorial Hospital Did Not Always Bill Correctly for Evaluation and Management Services Related to Diagnostic or Therapeutic Procedures and Supartz Injections

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Summary

Wing Memorial Hospital (the Hospital) (operating in Massachusetts) complied with Medicare billing requirements for 47 of the 156 claims reviewed. However, the Hospital did not fully comply with Medicare billing requirements for the remaining 109 claims, resulting in overpayments of approximately $104,000 for the period January 2, 2009, through March 2, 2012. Overpayments occurred primarily because the Hospital staff did not fully understand Medicare requirements for separately billable evaluation and management (E&M) services and did not have the necessary education to code the correct level of E&M service.

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