decisionhealth Newsletters, Answer Books - 2009 Issue 1 (January)
Concurrent Care / Medicare's rules on concurrent care
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Article Overview
This article summarizes Medicare’s policy framework for concurrent care as described in the Benefit Policy Manual. It focuses on the general circumstances under which more than one physician may be involved in a beneficiary’s treatment, how medical necessity is assessed, and why documentation matters for coverage review. The piece is most relevant to physicians, coders, billers, and compliance staff working with Medicare medical-necessity standards and physician-service policies.
Why This Topic Matters
Concurrent care questions can affect whether physician services are considered payable under Medicare, especially when multiple specialties or overlapping services are involved. Understanding the policy context helps reviewers evaluate documentation, medical necessity, and potential duplication concerns.
Article Sections
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E. Concurrent Care
Defines the general Medicare policy topic and discusses when multiple physicians may be involved in a beneficiary’s care. It addresses broad coverage considerations, documentation, and the role of carrier review.
What You Will Learn
- How Medicare describes concurrent physician care
- What broad factors are considered in evaluating medical necessity
- Why documentation of each physician’s role is important
- How coverage review may address overlapping physician involvement
Who Should Read This
- Medical coders
- Billers
- Compliance staff
- Physicians
- Practice managers
- Revenue cycle staff
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