Medicare Compliance & Reimbursement - 2019 Issue 2
Compliance: Clarify Condition for Clean Concurrent Care Claims
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Article Overview
This premium article reviews compliance issues in concurrent care billing for evaluation and management services when more than one physician is involved. It discusses how documentation, diagnosis selection, and claim support affect whether services appear concurrent or duplicative, and it is aimed at coders, auditors, compliance staff, and clinicians who manage shared patient care. The article uses a clinical scenario to illustrate general documentation considerations and payer scrutiny without replacing the need to read the full guidance.
Why This Topic Matters
Concurrent care claims can be denied or questioned when payer reviewers see overlapping services without clear documentation. Understanding the broad compliance issues helps billing and coding professionals support claims appropriately and reduce avoidable denials.
Article Sections
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Know the Difference Between ‘Concurrent’ and ‘Duplicative’
This section discusses the general distinction between concurrent care and duplicative care, along with the role of documentation in multi-provider treatment scenarios. It also references Medicare policy context and broad claim review considerations.
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Focus on Diagnosis Codes Associated with Multiple Conditions
This section covers how diagnosis reporting may differ when multiple clinicians are involved in a patient’s care. It uses a sample care scenario to illustrate broad documentation and coding considerations for E/M services.
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Stellar Notes Can Boost Your Claims Success
This section emphasizes the importance of strong clinical documentation when concurrent care claims are reviewed. It addresses general payer concerns and the need for clear support in the medical record.
What You Will Learn
- How concurrent care is distinguished from duplicative care in a compliance context
- Why documentation is central to supporting multi-provider E/M claims
- How diagnosis reporting may be approached when more than one clinician is involved
- What kinds of payer concerns can arise in shared-care situations
Who Should Read This
- Professional coders
- Compliance auditors
- Billing staff
- Physicians and clinical documentation staff
- Revenue cycle professionals
Codes Discussed
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