tci Medicare Compliance & Reimbursement - 2003 Issue 8

Medicare: OIG CONTINUES TO FRET OVER MULTIPLE PROCEDURE CLAIMS

As part of an extensive series of reviews on how well Medicare contractors handle Medicare claims from ambulatory surgical centers, the HHS Office of Inspector General has taken the measure of six carriers’ processing of multiple procedure claims. The results, as in other reviews, suggest that Medicare claims processors will be taking a closer look at ASC claims for multiple procedure claims performed in a single surgical session. Under Medicare rules, when multiple services are provided in the same operative session, the highest-paying procedure gets reimbursed in full while the others get paid at one-half the normal rate. However...

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