tci Part B Insider - 2016 Issue 11

Recovery Audit Contractors: RAC: The Doctor Isn't in? Don't Bill E/M for Diagnostic-Only ED Visits

If the patient is triaged but never sees a qualified healthcare professional, don’t report an E/M code. When a patient presents to the emergency department (ED), you can automatically report an ED evaluation and management code, right? Not so fast. If you don’t meet the criteria for billing an E/M service, you’ll be in hot water with your payer. That’s the word from a recent RAC announcement indicating that these types of claims are about to be scrutinized. Region B Is on the Case On Feb. 2, Region B recovery audit contractor CGI Federal announced...

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