tci Medicare Compliance & Reimbursement - 2004 Issue 42

Physicians: Carrier Guidance May Lead To Physician Overbilling

What the carriers leave out could be as important as what they say.If you're relying on your carrier's bulletins and FAQs to tell you how to bill for inpatient visits, then you could be courting trouble.Two recent carrier statements on inpatient visits either leave out crucial information or encourage physicians to bill a higher-paying code when a lower-paying code may be more appropriate, say experts.In a recent Frequently Asked Questions feature, AdminaStar Federal offered guidance that could be confusing at best. A provider put forward a situation in which a physician sees a patient in the...

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