In July, Utah pain doctor Jahan Imani, MD, and Intermountain Medical Management, P.C., entered into a nearly $400,000 settlement with the OIG to resolve allegations that Imani’s practice submitted false or fraudulent claims due to improper modifier use for payment by improperly using modifier -59 with HCPCS code G0431.
Mastering hierarchical condition categories (HCC) is key to success under new reimbursement methodologies that rely on risk-adjustment, quality, and value metrics such as the Quality Payment Program (QPP). Organizations need to take a close look at their training and audit programs to ensure that valuable information isn’t being left out of documentation—and negatively impacting HCC scores.
Tom, a 29-year-old, unemployed construction worker living on the East Coast, decides to drive on his own to the West Coast in hopes of finding a job. He avoids rest stops to decrease his total trip time. Halfway through his trip, he gets in a serious auto accident caused by another driver. The accident occurs in a state with mandated auto insurance.
