Auditing/Compliance Tips & Resources

Pre-Procedure H&P Is Bundled to Surgery, Decision for Surgery Is Not

As a general rule, an E/M service provided on the day of, or the day prior to, a major surgical procedure is included and paid for within the global surgical package of that ...

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Medical Necessity as a Fraud Theory

The US Department of Justice recently announced settlement of False Claims Act 9 (FCA) allegations against Extendicare Health Services, Inc. ("Extendicare") and its subsidiary Progressive Step Corporation ("ProStep"). The FCA allegations stemmed from allegations that Extendicare ...

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Quick Tip: Always Bundle Fluoroscopy to Endoscopic Procedures

If the provider uses fluoroscopic guidance during an endoscopic procedure, you may never report the fluoroscopic guidance separately, for Medicare payers. Per Chapter VII of the National Correct Coding Initiative Policy Manual for Medicare Services ...

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