decisionhealth Newsletters, Part B News - 2014 Issue 12 (December)
How to choose from 3 patient-monitoring codes to bill properly, avoid edits
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Article Overview
This article reviews three Medicare-related patient-monitoring and care-management services that can overlap in practice and create billing conflicts. It is aimed at primary care and other outpatient providers, as well as coding and reimbursement staff, who need a general understanding of how coverage policy, claim edits, and documentation requirements affect monthly monitoring and transitional care billing.
Why This Topic Matters
Understanding the interaction between payment policy and claim edits helps practices avoid denied claims and choose the appropriate monitoring service when more than one option appears possible.
What You Will Learn
- The broad differences among several Medicare monitoring and care-management services
- How claim edits and CPT policy can affect whether more than one service may be reported
- What general factors are considered when selecting among overlapping monthly monitoring options
- How timing, encounter type, and documentation burden can affect billing decisions
Who Should Read This
- Primary care providers
- Physician coders
- Billing staff
- Practice managers
- Reimbursement specialists
Codes Discussed
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