tci Medicare Compliance & Reimbursement - 2016 Issue 7

Compliance: Expect Enhanced Scrutiny of Diagnostic-Only ED Visit Claims

Double check whether a doctor saw the patient. If you bill for an emergency department (ED) evaluation and management (E/M) code without meeting the criteria, you could be inviting unwanted RAC attention. Region B is on the Case On Feb. 2, Region B recovery audit contractor CGI Federal announced that it will be reviewing services for patients who were triaged but weren’t examined or treated by a physician or physician extender, the RAC announced on Feb. 2. In black and white: “This issue targets emergency room services for triaged patients who are not seen by a qualified...

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