tci Medicare Compliance & Reimbursement - 2007 Issue 39
REIMBURSEMENT: Don't Treat A Second-Hand Problem Like A New Development
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Article Overview
This reimbursement-focused article compiles recent Medicare contractor FAQ guidance affecting documentation, diagnosis reporting, inpatient rehabilitation participation, emergency department risk assessment, and billing decisions for routinely non-covered services. It is aimed at coders, billers, and compliance staff who need to understand how contractor interpretations may affect claim preparation and medical record support without relying on the premium article itself.
Why This Topic Matters
The article highlights practical Medicare billing and documentation issues that can affect claim acceptance, E/M scoring, and whether a service should be submitted to Medicare at all. It is useful for teams that work with Part B claims, rehabilitation settings, and routine pre-operative or other non-covered services.
What You Will Learn
- How Medicare contractors distinguish between problems that are new to the patient and those that are only new to a provider
- Why diagnosis selection can depend on the documented finding reached after testing
- What general participation limits may apply to non-physician practitioners in inpatient rehabilitation settings
- How contractor guidance frames risk considerations for routine emergency department medication administration
- When a routinely non-covered service may not need to be billed to Medicare
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Compliance professionals
- Physician practice managers
Codes Discussed
Modifiers Discussed
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