5 tips to help your critical care services claims withstand audits

Why This Topic Matters

Critical care claims are closely scrutinized in audits, so correct documentation and timing are essential for supporting medical necessity and avoiding denials. The article helps readers understand the general compliance issues that commonly affect these claims.

Article Sections

1. Billing

   Introduces the article’s focus on critical care billing and audit risk. It frames the discussion around situations that commonly create confusion in hospital-based claims.

2. Don’t assume that a patient in intensive care is eligible for a critical care service (99291-99292).

   Discusses how critical care eligibility relates to patient condition rather than location alone. The section contrasts scenarios that may or may not support critical care in an inpatient setting.

3. Order of E/M, critical care a factor

   Summarizes the importance of service sequence when critical care and evaluation and management services occur on the same date. It also references Medicare manual guidance relevant to that topic.