tci Medicare Compliance & Reimbursement - 2019 Issue 4
Compliance: Master Concurrent Care With These Expert Tips
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Article Overview
This compliance-focused article discusses concurrent care in a medical coding context, with emphasis on documentation quality, claim support, and distinguishing concurrent services from duplicative care. It is aimed at coders, compliance staff, and clinicians involved in E/M and inpatient-related billing reviews. The article covers general guidance on diagnosis ordering, payer scrutiny, and the importance of clear clinical records when more than one provider is involved in a patient’s care.
Why This Topic Matters
Concurrent care claims are often reviewed closely, and unclear documentation can lead to denials or questions about whether services overlap. Understanding the documentation and reporting considerations helps teams support claims and reduce avoidable billing problems.
Article Sections
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Know the Difference Between ‘Concurrent’ and ‘Duplicative’
Introduces the distinction between concurrent and duplicative care and discusses why documentation and diagnosis ordering matter when more than one provider is involved.
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Focus on Diagnosis Codes Associated with Multiple Conditions
Covers concurrent care situations involving more than one condition and different provider roles, with emphasis on how diagnosis reporting may vary by payer and clinical circumstance.
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Top-Notch Notes Boost Your Claims Success
Discusses the role of complete progress notes and clinical record support when payer review raises questions about concurrent versus duplicative care.
What You Will Learn
- How concurrent care is distinguished from duplicative care in a coding and compliance context.
- Why documentation quality is especially important when multiple providers are involved.
- How diagnosis reporting considerations can differ when more than one condition or provider is part of the case.
- Why payer review may focus on whether services appear overlapping or separately justified.
Who Should Read This
- Medical coders
- Coding compliance staff
- Physicians and clinical documentation staff
- Billing and claims review teams
Codes Discussed
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