tci Part B Insider - 2018 Issue 8

Part B Statistics: Review Critical Care Service Benchmarks to See Where You Fall

Over 10,000 Part B providers received CBRs to help clean up their claims. As with many claims issues, medical necessity dictates critical care services. However, due to confusion over CMS’s criteria for the use of the E/M codes, critical care remains a perennial favorite on Medicare claims auditors’ checklists. Details: In a new Comparative Billing Report (CBR), Part B MAC Palmetto GBA looked at trends and billing issues that the payer has seen for Medicare providers who bill critical care services. Palmetto launched the analysis of the E/M claims “because improper payment rates are high for...

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