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A $900,000 settlement and a Medicare administrative contractor’s (MAC) call to perform internal reviews are the latest reminders that incident-to billing remains a challenge. Failure to stay compliant can erase the additional revenue a practice might earn from billing a non-physician’s service under a physician’s name.
A recent string of embezzlement cases underscores the danger this type of fraud poses to practices and health systems, even those with well-funded financial management programs. Don’t rely on the usual audit processes to catch potential embezzlement activity; instead, you should actively monitor for and deter it.
Selecting the appropriate subsequent care code can be daunting as CPT codes 99231-99233 are similar and coding is based, unlike office visits, on the documentation of two of three key components. Sharpen your coding prowess by navigating the differences between the coding and documentation requirements.
On March 1, Aetna joined the long list of private payers that have cut coverage of office consults (99241-99245).
While many phone and online services jumped in 2020, transitional care management (TCM) hit a huge snag in utilization. However, despite the lower number of claims, providers had less trouble than ever getting their claims accepted.


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