peanutbutterkisses
Contributor
I have a provider that does not want to bill additional E/M visits with Preventive visits. The AAPC's CPMA study guide says, "When auditing preventive services, it may be the policy of the office to bill for a preventive service only, and not to bill for a problem visit even if one is provided. An external auditor may suggest an alternative to this policy based on documentation, but it is best to understand the office policy prior to reviewing the medical record".
I thought we had to bill based on documentation. Wouldn't undercoding be a potential violation of fraud and abuse rules and even establish false utilization patterns that could flag physicians as outliers and subsequent targets for payer investigations and/or audits. Underbilling can also affect the amount patients owe and how soon they meet their deductible.
Did anyone have guidelines they can direct me to to verify this is compliant?
I thought we had to bill based on documentation. Wouldn't undercoding be a potential violation of fraud and abuse rules and even establish false utilization patterns that could flag physicians as outliers and subsequent targets for payer investigations and/or audits. Underbilling can also affect the amount patients owe and how soon they meet their deductible.
Did anyone have guidelines they can direct me to to verify this is compliant?