Follow these 5 billing ‘don'ts' to avoid a costly Medicare audit

Why This Topic Matters

The topics addressed can affect audit exposure, claim accuracy, and compliance with Medicare billing rules. It is especially relevant for practices that submit Medicare claims for office visits, injections, preventive services, or emergency department-related services.

Article Sections

1. Billing and compliance pitfalls to avoid

   Introduces common situations that may draw Medicare scrutiny and frames the article as a list of compliance-focused billing concerns.

2. Credentialing and provider identification

   Discusses claim submission concerns related to provider enrollment and billing under another practitioner’s identification information.

3. Appropriate use of low-level evaluation and management visits

   Covers billing concerns involving minor office visits and services performed by protocol or in conjunction with other procedures.

4. Preventive visits versus sick visits

   Explains the broader issue of separating wellness services from problem-oriented services and the impact of payer-specific rules.

5. Diagnosis accuracy and visit characterization

   Addresses the importance of matching diagnosis coding to the patient’s current condition and avoiding outdated or misleading labels.

6. Emergency department coding and place of service

   Reviews when emergency department billing categories are applicable and highlights the importance of the service location.