ED Coding & Reimbursement Alert - 2014 Issue 13
Industry Notes
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Article Overview
This article collects several brief industry notes relevant to medical coding, billing compliance, and payer policy. It summarizes a federal fraud case involving Medicare billing, a contractor reminder about how record markup can affect readability during review, and an update on a payer’s handling of claims that pair an office procedure with evaluation and management services. It is most useful for coders, billers, compliance staff, and practices that need awareness of current audit and reimbursement issues.
Why This Topic Matters
The piece highlights issues that can affect compliance, documentation quality, and claim payment behavior. It helps readers spot policy and enforcement trends that may influence daily coding and billing workflows.
Article Sections
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Medicare fraud case
A brief report on a federal enforcement action involving alleged improper Medicare billing and related fraud activity. The note focuses on the case background and legal action taken.
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Documentation highlighting guidance
A short contractor advisory about how markings in medical records can affect legibility during review. The section summarizes general guidance on presenting documentation for audit purposes.
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Policy update on billing an office procedure with E/M services
An update on a payer policy change affecting claims that combine an office-based procedure with evaluation and management services. The note references claim processing and related documentation handling.
What You Will Learn
- How a reported Medicare fraud case was framed in an industry update
- What general documentation-marking concerns were raised by a Medicare contractor
- What type of payer policy change was described for claims involving an office procedure and E/M services
- Which organizations were referenced in connection with the article’s billing and compliance topics
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practices
- ENT practices
- Revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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