decisionhealth Newsletters, Coder Pink Sheets - 2013 Issue 12 (December)
Watch for increase in targeted reviews by your Medicare carrier
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Article Overview
This article covers a Medicare contractor policy update tied to targeted prepayment review activity and the role of data analysis in identifying claims for review. It is relevant to providers, coders, and billing staff who want to understand the broader compliance context, the reasons certain practices may be monitored more closely, and the general impact on evaluation and management and diagnostic test billing oversight.
Why This Topic Matters
Medicare review activity can affect claim payments, documentation expectations, and compliance risk for practices that bill atypically compared with peers. Understanding the policy shift helps organizations monitor billing trends and prepare for increased contractor scrutiny.
What You Will Learn
- How Medicare contractor review activity is changing
- Why data analysis may influence targeted review selection
- Which billing patterns may attract closer scrutiny
- How practices can think about monitoring their own billing trends
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Compliance professionals
- Practice managers
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