Pay Per View: Know critical care billing, documentation requirements
APCs Weekly Monitor, March 14, 2008
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Physicians who take chances by skirting ethics to increase their revenue risk massive financial penalties and the possibility of losing their freedom.
One Philadelphia hospital group was forced to pay $30 million in fines for fraudulent billing.
New Jersey's Blue Cross and Blue Shield recovered more than $10 million from physicians who billed for procedures with inappropriate codes or without ever having performed the stated procedure.
Medicare recovers thousands of dollars daily from physicians who bill a higher professional level than that which the patient's actual acuity level validates. The physicians do this with the erroneous expectation that no one will ever investigate them. Insurers' investigations often reveal healthcare providers who bill for services they never rendered; products they never delivered; misrepresented, unbundled, medically unnecessary, or duplicate services; increased units of services; false cost reports; kickbacks--and the list goes on.
Click here to learn more about critical care billing and documentation requirements. Medical Records Briefing subscribers have free access to this article in the February issue via their online subscriptions.
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