HHS OIG Targets Ophthalmology Practices for Medicare Billing Compliance: Eight Key Takeaways | McGuireWoods LLP

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One of the most challenging billing compliance issues ophthalmology practices encounter in coding and reimbursement is understanding when services provided on the same day as a surgical procedure are payable separately from Medicare’s “global surgery payment.” On March 29, 2021, the U.S. Department of Health and Human Services’ (HHS’) Office of Inspector General (OIG) released a report,
An Ophthalmology Clinic in California: Audit of Medicare Payments for Eye Injections of Eylea and Lucentis, examining these issues in an audit of an ophthalmology practice’s billing of Medicare for intravitreal injections and other services provided to patients on the same day as the injections. The clinic was not specifically identified by the OIG, but is located in Newport Beach, California, and opened in 2008.

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