Wiki Fraud


True Blue
Las Vegas, NV
Best answers
Would it be considered fraud if an Urgent care clinic is billing for global xrays and not dictating a separate xray report. There is not even views mentioned in the report. It is my understanding if the physician wants to bill for the reading there has to be a separate dictated report.
IOM 100-4, chapter 13, section 100.1
"A professional component billing based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the
field, does not meet the conditions for separate payment of the service."

IOM is the Internet Only Manual for CMS. You can access it by going to the CMS website and then going to the heading Regulations and Guidance, under Guidance you'll find Manuals.