What is an example of misuse under CMS definitions?

The definition of misuse under CMS (Centers for Medicare & Medicaid Services) involves actions that result in billing errors without intentional fraudulent behavior. In this context, failing to maintain adequate billing records is a clear example of misuse. Inadequate documentation can lead to improper billing practices, as it prevents the verification of services provided and the proper justification for those services in the claims submitted. This lack of documentation can lead to billing errors that are not necessarily due to fraud but can still be considered misuse as they violate CMS billing requirements and standards.

On the other hand, the other examples provided relate to different issues within the spectrum of compliance and medical billing. Billing for services at medically necessary levels aligns with proper practices, while providing unnecessary services would lean towards fraud, as it indicates intent to benefit financially from unnecessary procedures. Charging non-Medicare patients less does not pertain to CMS definitions of misuse at all but instead demonstrates different billing practices outside of Medicare regulations. Thus, the notion of misuse is firmly captured in the lack of adequate billing records and its implications for the overall integrity of the medical billing process.