Outpatient Facility Coding Alert - 2015 Issue 24
RAC Audits: This RAC Illuminates 2 Commonly-Miscoded Services
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Article Overview
This article reviews two Part B billing issues highlighted by a recovery audit contractor and explains why they draw auditor attention. It is aimed at coding and billing staff who want to understand the general categories of risk covered in RAC case studies and related Medicare guidance.
Why This Topic Matters
The topic matters because these kinds of claims issues can trigger payment recovery, audit scrutiny, and avoidable reimbursement problems for Part B practices.
Article Sections
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Billing for Discarded Drugs
Discusses one audit example involving drug billing practices for multi-use vial situations and the broader compliance concern raised by discarded amounts.
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Unbundling Claims
Covers a second audit example involving reporting related imaging services and the general issue of improper code combination reporting.
What You Will Learn
- What kinds of Part B billing issues recovery audit contractors commonly flag
- Why drug wastage billing can create compliance risk
- How unbundling concerns arise in claims review
- What general resources are referenced for correct coding review
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practice managers
- Part B providers
Codes Discussed
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