Quote:
Originally Posted by Caymus
When did the "questionable" billing start?
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The questionable billing has caught up a lot of providers across the country including myself at one point.
What Medicare did awhile back to save money was to ‘bundle’ a bunch of services, with their own unique CPT codes, that were usually performed together into a single ‘bundled’ code with its own CPT code.
The reimbursement for all those ‘bumbled’ codes was significantly less then if the provider billed each separately.
For example, you go to a PT visit: you get stretching session, Heat treatment, weight session, gait training, kinesiotherapy taping and advice on ADL’s .
The PT clinic submits all these codes to
Medicare and might get reimbursed over $1,000.
So what Medicare did was ‘bundle’ all this and billed under a couple codes, lowering the reimbursement level to maybe $125 no matter what the therapist did.
Same for a surgery. Instead of billing for every sponge, aspirin, suture provided, Medicare ‘bundled it all under the umbrella of a single CPT code. So instead of getting reimbursed the ‘old’ way, Medicare might pay $35k for the entire procedure as a global fee.
Technically what TVH did wasn’t illegal, but it did violate Medicare rules. The trouble is, Medicare is slow but relentless. When it gets around to auditing a doctor, clinic or organization like TVH, it will claw back all the overpayments plus interest PLUS a hefty penalty.
I am sure TVH actually received overpayments that were much less than the hundreds of millions of dollars figure bandied about, but with heavy interest and penalties going back a number of years, it was a crippling blow.
Medicare will set the amount and then withhold any further reimbursements for patients until all the funds are paid back.
That would be a crippling blow to TVH leaving bankruptcy and sale of the organization their only option.