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Thread: NEED QUICK response! Coding Policy...Fraud?

  1. #11
    Join Date
    Apr 2007
    North Carolina


    AAPC: Back to School
    I do understand your view, Laura, and this may be why some physicians are requesting the patients to reschedule their PE's and choose to address the "problem" that is present. I think Medicare developed this "carve out" rule so that the beneficiaries would not be subjected to unfair monetary liabilities. If a physician chooses to treat a "problem" at the same time as the wellness exam, it does make sense that some of the history, exam and MDM would be credited to the problem oriented visit...there is a portion of the visit that is not dedicated solely to the wellness exam. As a result, Medicare created a "window" of medical necessity for their liability. I don't necessarily agree with all of Medicare's rules, guidances, etc, but if it's in "black and white", I follow those guidelines. I don't want to compromise abuse. I know what's correct...I know what can be billed...therefore, we have to put it to paper. Senior citizens are being encouraged to report fraud/abuse. I just don't want to be on the receiving end of an audit


  2. #12

    Default Medicare wellness and modifer 25

    So how do we manage the provider that wants to bill for the wellness and a new diagnosis with a separate E&M with a 25 modifier?

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