As Thanks to a whistleblower who served as a billing coder and auditor at Duke, the government recovered $1,000,000. Call 844-334-2816 to speak with a specialist now. Doctors must document the care that they provide to patients and then bill for the procedure using standard billing codes that represent a particular service or procedure. Coders should bundle services when CPT coding rules require them to do so. Telephone:(800) 292-1919Email:intake@medicalbillinganalysts.com. Another type of upcoding is to bill for a visit that involved more time than it actually did. assigning 0 ir 9 as the 4th or 5th digit instead of reviewing the coding manual for the appropriate code. The NCCI table shows that CPT code 92020 Gonioscopy became bundled with CPT code 65855 Argon laser trabeculoplasty or selective laser trabeculoplasty on Jan. 1, 1996, with an indicator of 1. HCPCS Level II codes and modifiers are maintained by the Centers for Medicare & Medicaid Services (CMS). Part of that includes ensuring there arent any billing errors causing damage to the bottom line. We can also efficiently manage your insurance verification and prior authorization needs. Whistleblowers are crucial to the important mission of uncovering and stopping unethical medical billing practices. A example of upcoding in healthcare could be a Medicare patient visits a doctor for an annual routine checkup, a service typically Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Table 1 shows the complete listing of NCCI PTP-associated modifiers. It remains one of the most pervasive and troubling forms of Medical Coding 3 Major Medical Coding Mistakes That Providers Must Know And to make matters worse, medical coding mistakes expose your practice to penalties ranging from thousands to millions of dollars. Medical billing experts also help lawyers by identifying unreasonable and fraudulent billings. These modifiers belong after pricing modifiers on the claim.
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