tci Medicare Compliance & Reimbursement - 2018 Issue 13

Review These Critical Care Service Examples

Tip: Both the illness and treatment must fit into Medicare’s parameters. With critical care services, it’s important to pick the code that fits the circumstances and is easily backed up by the documentation. Without the medical cause-and-effect combination supported by the agency’s nuanced guidelines, your claims may head to the audit zone. “Providing medical care to a critically ill patient should not be automatically deemed to be a critical care service for the sole reason that the patient is critically ill or injured,” cautions CMS in the Medicare Claims Processing Manual, Chapter 12, Section...

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