With COVID ‘Season’ Approaching, Don’t Let Sloppy Coding Put You in Jeopardy

While it may be premature to call the upcoming months “COVID season,” it’s a fact that case and hospitalization rates are starting to climb in multiple U.S. states. As such, it’s a good time to reconsider the importance of keeping your coding on point. The consequences of getting it wrong could result in underpayment—clearly not good for any business—but the consequences could be far worse if improper coding results in patients and payers being billed excessively. An urgent care provider was convicted for what the U.S. Justice Department called “false and fraudulent claims to Medicare and a commercial insurer for patients who received COVID-19 tests at his testing sites.” As outlined in the DoJ’s announcement, the urgent care physician-owner instructed employees at two Maryland drive-through testing sites to bill patients for higher-level evaluation and management visits. The resulting claims amounted to millions of dollars billed to Medicare  and tens of thousands of dollars billed to a commercial insurer. Sentencing is scheduled for November 2023.