decisionhealth Newsletters, Part B News - 2014 Issue 6 (June)
RAC alert: Admitting, discharging docs must be same group, same specialty
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Article Overview
This article addresses Medicare audit activity related to hospital discharge-day management services and how physician group and specialty enrollment can affect billing compliance. It is relevant to physicians, hospitalists, coders, compliance staff, and practice managers who handle inpatient admission and discharge workflows. The article discusses the policy backdrop, the audit concern, and related guidance from Medicare resources and contractors.
Why This Topic Matters
The topic matters because hospital discharge billing can be scrutinized in audits when admitting and discharging physicians are not aligned under Medicare’s group and specialty rules. Practices need to understand the compliance environment to reduce recoupment risk and to review internal enrollment and workflow arrangements.
Article Sections
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Recovery auditors
Introduces the audit issue and the Medicare payment concern associated with hospital admission and discharge workflows across physician specialties.
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Watch for problems with surgical patients
Discusses the issue in the context of surgical inpatients with additional medical needs and references contractor guidance and audit activity.
What You Will Learn
- How Medicare audit attention relates to inpatient discharge-day management billing
- Why physician group and specialty enrollment can affect hospital discharge workflows
- What kinds of inpatient scenarios may raise compliance concerns
- Which Medicare and contractor resources are referenced in the discussion
Who Should Read This
- Physicians
- Hospitalists
- Medical coders
- Compliance professionals
- Practice managers
- Billing staff
Codes Discussed
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