tci Medicare Compliance & Reimbursement - 2007 Issue 20
PART B: Check With Your Local Carrier For Concurrent Critical-Care Coverage
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Article Overview
This article discusses Medicare Part B billing considerations for critical care when more than one physician may be involved during the same time period. It focuses on local carrier policy differences, claim denials, appeals, coordination among providers, and documentation expectations. The guidance is aimed at coders, billing staff, and physicians who work with hospital critical care claims and need to understand carrier-specific rules and supporting records.
Why This Topic Matters
Concurrent critical care claims can be denied if carrier policies limit billing to one physician per hour or if records do not support the time and circumstances billed. Understanding local guidance helps reduce denials, improve documentation, and support appeals when necessary.
What You Will Learn
- How local carrier policies can affect critical care billing under Medicare Part B
- Why checking carrier FAQs and local guidance is important before submitting claims
- How concurrent physician involvement may lead to claim denials or appeals
- What types of documentation and record review may support billing review
- General documentation expectations related to critical care time and patient availability
Who Should Read This
- Physicians
- Medical coders
- Billing staff
- Revenue cycle teams
- Hospital compliance staff
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