decisionhealth Newsletters, Coder Pink Sheets - 2006 Issue 5 (May)
OIG says 3/4 Medicare consults weren't really consults
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Article Overview
This article covers an OIG report on Medicare consultation claims, including how often billed consults were found to be unsupported, misclassified, or coded at an unsupported level. It matters for coding and compliance professionals who work with evaluation and management services, consult documentation, and audit risk in Medicare billing. The article presents a high-level summary of the audit findings and the types of consult billing issues identified.
Why This Topic Matters
It helps readers understand a Medicare audit finding affecting consultation billing compliance, documentation review, and claims accuracy.
What You Will Learn
- How an OIG audit evaluated Medicare consultation claims
- The broad categories of consult billing problems identified in the report
- Why consultation documentation and level selection are important for compliance review
- What kinds of Medicare claims were included in the audit summary
Who Should Read This
- Medical coders
- Coding auditors
- Compliance staff
- Physician billing staff
- Healthcare revenue cycle professionals
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