Issue link: https://beckershealthcare.uberflip.com/i/1187260
34 CODING & BILLING The top, bottom revenue-generating specialties for hospitals By Rachel Popa C ardiovascular surgeons generate the most revenue for hospitals on aver- age, according to Merritt Hawkins' 2019 Inpatient/Outpatient Revenue Survey. Merritt Hawkins emailed a survey to 3,000 hospital CFOs and other financial manag- ers across the U.S. from October 2018 to December 2018. Hospital CFOs and finan- cial managers reported the combined net inpatient and outpatient revenue generated by a full-time equivalent physician employed by the hospital or in independent practice. Primary care physicians determined revenue from direct hospital admissions, lab tests and procedures performed. e survey was completed by 62 respondents, representing 93 separate hospitals. e top 10 revenue-generating specialties: 1. Cardiovascular surgery: $3,697,916 2. Invasive cardiology: $3,484,375 3. Neurosurgery: $3,437,500 4. Orthopedic surgery: $3,286,764 5. Gastroenterology: $2,965,277 6. Hematology/oncology: $2,855,000 7. General surgery: $2,707,317 8. Internal medicine: $2,675,387 9. Pulmonology: $2,361,111 10. Non-invasive cardiology: $2,310,000 Bottom nine revenue-generating special- ties: 11. Urology: $2,161,458 12. Family practice: $2,111,931 13. Neurology: $2,052,884 14. OB-GYN: $2,024,193 15. Otolaryngology: $1,937,500 16. Psychiatry: $1,820,512 17. Nephrology: $1,789,062 18. Pediatrics: $1,612,500 19. Ophthalmology: $1,440,217 n ASC among 8 defendants involved in $6.65M settlement over billing fraud allegations By Angie Stewart R etina Institute of California Medical Group and seven other defendants paid $6.65 million to settle allegations that they defrauded Medicare and Med- icaid, though they did not admit liability, according to the Department of Justice. Retina Institute, its former CEO, three of its physicians and three affiliated entities allegedly violated the False Claims Act by illegally billing Medicare and Medicaid/Medi-Cal between January 2006 and August 2017. Retina Institute has multiple locations throughout California. Retina Institute and the other defendants were accused of: • Misclassifying simpler exams as ones involving patients with severe or emergency conditions to obtain higher payments • Waiving Medicare copayments and deductibles without proper documentation of patients' financial hardship • Billing Medicare and Medicaid for services that weren't performed, necessary, documented or in compliance with rules and regulations Four individuals were listed as defendants: Tom S. Chang, MD, Michael A. Samuel, MD, Michael J. Davis, MD, and Brett Braun, the former CEO of Retina Institute of Califor- nia Medical Group. The corporate entities named as defendants alongside Retina Institute were Tom S. Chang MD Inc., Pasadena- based California Eye and Ear Specialists, and San Gabriel (Calif.) Ambulatory Surgery Center. California Eye and Ear Specialists is a subsidiary of Trilogy Eye Medical Group where Drs. Chang and Samuel serve as senior executives. The allegations were put forth in a whistleblower lawsuit filed by two former Retina Institute administrators, Bobbette A. Smith and Susan C. Rogers. They will receive a share of the settlement. The amount has yet to be determined. The claims settled are only allegations; the defendants did not admit liability. n A whistleblower accused Retina Institute of California Medical Group of billing for services not provided, waiving Medicare copayments and deductibles, and more