Review of Place of Service Coding For Physician Services - Wisconsin Physicians Service Insurance Corporation, Madison, Wisconsin

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.