Medicare Compliance & Reimbursement

Check out this succinct 'million dollar statement' to cinch documentation requirements. Are your cardiology or specialty practice's evaluation and management services garnering fair Medicare payment -- or are they a ticket to potential reimbursement recoupments and worse? The answer can lie in the details that both keep the cash flowing and your compliance record on the high road. A costly assumption: "Some cardiologists will assume that they have sicker patients and can bill higher level E/M codes ...," says Leatrice Ford, RN, founder of ConsultCare Partners in Louisville, Ky. "But a family practice physician managing a cardiac failure patient in and out of the hospital will potentially have sicker patients, as the patient usually has other issues, such as renal impairment and diabetes." "If a physician is consistently coding level 5s, that will trigger the MAC to take a look," counsels Sandy Fuller, CPC, MCS-P, HIS supervisor and compliance officer for [...]