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Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Place of Service Coding For Physician Services - Wisconsin Physicians Service Insurance Corporation, Madison, Wisconsin," (A-05-04-00025)

October 7, 2004


Complete Text of Report is available in PDF format (148 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.


EXECUTIVE SUMMARY:

The objective of this audit was to determine the extent of Medicare Part B overpayments made to physicians by Wisconsin Physicians Service Insurance Corporation (WPS) for billings with incorrect place of service codes.  Seventy-nine of 100 sampled physician services were performed in a facility, but were inappropriately billed by a physician using the incorrect “office” place of service code.  Medicare regulations provide for higher payment for medical procedures that are performed in non-facility settings versus those performed in facility settings.  We recommended that WPS (1) recover identified overpayments totaling $1,948; (2) work with the physician population to reassess their billings and refund estimated overpayments totaling $742,510; (3) educate physicians about the importance of correctly reporting place of service codes; and, (4) work with the Medicare fiscal intermediary to identify physician services with potentially high risk for place of service coding errors, and recover program overpayments that result from these errors.