U.S. flag

An official website of the United States government

Dot gov

The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Department of Health and Human Services

Office of Inspector General -- AUDIT

"Review of Place of Service Coding for Physician Services," (A-02-04-01010)

January 26, 2005


Complete Text of Report is available in PDF format (259 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 Empire Medicare Services (Empire) for billings with an incorrect place of service code.  Eighty-eight of 100 sampled physician services were performed in a facility, but were incorrectly billed by the physicians to Medicare Part B using the “office” place of service code.  To account for the increased practice expense incurred by physicians in their offices, Medicare reimburses a higher amount for services performed in this setting.  We recommended that Empire:  (1) recover $3,641 of identified overpayments; (2) work with the physicians represented in the population of potential errors to reassess their billings and to refund any overpayments estimated at $1,467,318; (3) strengthen its education process and re-emphasize to physicians, the importance of correctly reporting the place of service, and the need for internal control systems to prevent Medicare billings with incorrect place of service codes; (4) instruct physicians to notify their billing agents of the importance of using correct place of service codes; and (5) work with the Program Safeguard Contractor or the Fiscal Intermediary to perform a data match on an ongoing basis, to identify physician services having a high potential for error due to place of service miscoding, and to recover program overpayments that result from these errors.  Empire generally concurred with our findings and recommendations.