Five Gotcha Medicare Myths That Can Do Harm

Because the healthcare world is so highly regulated, assertions that you “must” or “can’t” perform a particular action are common. Because the penalties for legal violations are so draconian, there is a strong incentive to heed these warnings.

But sometimes the warnings mischaracterize the law. It may be that a well-intentioned employee wants to be sure that the organization isn’t even close to violating the law. Sometimes the motivation is less pure, and a payer, lawyer, or consultant overstates the law in the hopes that your reaction will benefit them financially.

To start the new year, here are five multiple-choice questions that highlight common Medicare myths. 

1. If you discover that a physician failed to sign about 400 office visits, you should:

A)  Before 60 days elapse, refund all payments for the services.
B)   Before 60 days elapse, refund all Medicare payments, but not other payments.
C)  Have the physician sign the charts, dating them the date of service.
D)  None of the above.

2.  A review of 20 chart finds that the documentation does not meet the E&M Guideline for the code billed. You should:

A)  Before 60 days elapse, refund the whole payment received.
B)   Before 60 days elapse, refund the difference between the code billed and the code supported.
C)  Before 60 days elapse, refund Medicare claims for the difference between the code billed and the code supported.
D)  None of the above.

3.  You are engaging a consultant for a routine review of billing practices:

A)  If you use an attorney to engage the consultant, you can be certain the review isn’t discoverable.
B)   In order for the review to be protected, your lawyer must write a check to pay the consultant’s bill.
C)  The review is privileged only if the lawyer personally does the work.
D)  None of the above.

4.  Which of the following statements about Medicare’s two-midnight rule is false?

A)  The patient must stay for two midnights.
B)   If the patient stays for two midnights, there is no need to worry about a physician order.
C)  There is no requirement to use InterQual to decide whether to admit a Medicare patient.
D)  None of the above.

5.   When setting prices for your healthcare services:

A)  You must have the same fee for every patient.
B)   You must charge Medicare your lowest price.
C)  You may not ever waive a copayment.
D)  None of the above.

While these may be tricky questions, they are certainly not trick questions. Most hospitals and clinics will have to address most of these questions each year. Many of the questions touch on several different laws. In some cases, both state and federal law must be considered, and this means that the answers may not be obvious. 

When in doubt, guess “D.”  

Program Note

To get the answers, as well as a detailed explanation of the underlying rationale, register for  the upcoming webcast,“Debunking 5 Medicare Myths That Can Hinder and Hamper Your Judgment,” 1:30 p.m. EST on Tuesday, Jan. 24 by clicking here.  



David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

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