E/M Coding Alert - 2014 Issue 19
Industry Notes: CMS Explains Difference Between NPI and PTAN
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Article Overview
This article summarizes several Medicare and health care compliance developments. It explains the general difference between two provider identifiers used in Medicare workflows, reports on allegations in a cardiology fraud case involving unnecessary services and billing issues, and notes an American Hospital Association request concerning how audit findings are calculated. The piece is useful for providers, coders, compliance staff, and revenue cycle professionals tracking Medicare administration and enforcement activity.
Why This Topic Matters
It helps readers stay current on Medicare identification basics, fraud-and-abuse enforcement themes, and broader audit methodology concerns that can affect billing compliance and reimbursement risk.
What You Will Learn
- How Medicare provider identifiers are discussed in relation to claims and contractor communications.
- What types of billing and medical necessity allegations are highlighted in a cardiology enforcement case.
- Why a hospital association is concerned about Medicare audit error extrapolation.
- Which organizations and government entities are involved in the topics covered.
Who Should Read This
- Medical coders
- Billing staff
- Compliance officers
- Revenue cycle teams
- Physicians and provider organizations
- Health care administrators
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