Witch Hunt!

While Halloween may have just passed, the Witch Hunt apparently is just beginning. Two different physicians in two different states who have Noridian as their Medicare Administrator (MAC) have received letters noting a PRE-Payment audit of some of their claims.

The first practice is having their ablations (36475) audited while the second is having their ultrasounds (93970) audited. Of substantial interest is why they are being audited. It is not due to any reports of malfeasance or inappropriate care. The letters from Noridian quite clearly state they are being audited because they are the number two and number three providers paid for these services respectively. In short, they are being audited because they provide a lot of services.

While you may not have Noridian for your MAC, we have frequently seen ideas like this migrate from one MAC to the other, from one payer to another. As always, we recommend prudent medical care that is well documented from the first visit through the last.

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