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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
A-01-20-00503
Report Type
Audit
Number of Recommendations
4
Questioned Costs
$56,016
Funds for Better Use
$4,939,586

Open Recommendations

This report has 2 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
23-A-01-018.03 No $0 $4,939,586

We recommend that the Centers for Medicare & Medicaid Services strengthen its system controls to detect and prevent improper payments to providers for incorrectly billed: (1) co-surgery services, (2) assistant-at-surgery services, and (3) duplicate services—which could have saved approximately $4,939,586 during our audit period.

23-A-01-018.04 No $0 $0

We recommend that the Centers for Medicare & Medicaid Services update its Medicare requirements and corresponding educational material to improve providers' understanding of the Medicare Part B billing requirements for co-surgery procedures, including: updating the Medicare Claims Processing Manual, chapter 12, section 40.8, to ensure billing providers understand that two physicians performing procedures as co-surgeons (including bilateral procedures) must append the co-surgery modifier regardless of whether they are in the same specialty or in different specialties, and providing additional education material to providers clarifying that spinal instrumentation procedure codes must be billed with a co-surgery modifier under Medicare Part B when performed as a co-surgery.

Department of Health & Human Services OIG

United States