decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Clinical Lab Services / Fraud alerts / Inappropriate diagnostic testing
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Article Overview
This premium article describes a Medicare fraud alert focused on inappropriate diagnostic testing, marketing practices used to recruit beneficiaries, and the types of services that were reportedly billed. It is relevant to coders, compliance staff, auditors, and clinicians who need to understand the general scope of the issue and the code sets and service categories implicated.
Why This Topic Matters
It helps readers recognize a compliance risk area involving diagnostic test billing, office visit reporting, and specialty mismatch patterns in Medicare claims.
What You Will Learn
- The general nature of the fraud alert and the setting in which it occurred.
- The broad categories of diagnostic and evaluation services implicated in the report.
- Why diagnostic testing and office service billing can be a compliance concern in Medicare claims.
- The specialties and practice patterns referenced in the alert.
Who Should Read This
- Medical coders
- Compliance officers
- Billing staff
- Auditors
- Physicians
- Practice managers
Codes Discussed
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