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Self-Administered Drugs. Drugs that can usually be self-administered are not covered by Medicare “Usually” means more than 50 percent of the time the drug is used by Medicare beneficiaries (Source: CMS Program Memorandum AB-02-072). Submission of accurate claims and information.
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Self-Administered Drugs • Drugs that can usually be self-administered are not covered by Medicare • “Usually” means more than 50 percent of the time the drug is used by Medicare beneficiaries (Source: CMS Program Memorandum AB-02-072)
Submission of accurate claims and information OIG Supplemental Guidelines
Outpatient Risk Areas - APC • Improper coding • Improper modifiers • Inpatient-only procedures • Medically unnecessary services • Outdated Charge Masters
Outpatient Risk Areas - CAH • Erroneous cost reporting • Improper billing of Observation services • Outdated Charge Master • Medical necessity issues • Incorrect provider-based designation
