As audits spike, stick to medical necessity, bundling rules for 99291-99292 claims

Why This Topic Matters

Critical care claims are high-volume, high-dollar services that attract federal review, so understanding the compliance areas discussed in the article can help practices assess whether their documentation and billing processes align with Medicare expectations.

Article Sections

1. Audit scrutiny and Medicare work-plan attention

   Introduces the increased federal interest in critical care billing and the organizations involved in oversight activity. It frames the broader compliance environment for these services.

2. Align your coding standards

   Reviews Medicare-oriented considerations for determining when critical care reporting is appropriate versus when other evaluation and management services may be more suitable. It also discusses the general clinical circumstances and documentation themes that affect claim support.

3. Mind bundled care codes

   Covers the topic of services that are included with critical care reporting and the audit concern around separate billing of related services. It highlights the bundling issue at a general level.

4. Time matters

   Discusses the time-based nature of critical care reporting and the importance of documenting the service interval. It also touches on broad time-aggregation concepts and related documentation considerations.