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8.16.2016

Medical Compliance Services Tips of the Month

Physician Billing Compliance Tip

Insufficient documentation continues to be a leading cause of Medicare noncompliance for providers who bill for CT scans.

The CMS Provider Minute: CT Scans Video includes pointers to help you properly submit claims with sufficient documentation.

Hospital and Physician Office Billing Compliance Tip

Question: What is the difference between a discharge and an acute care transfer?

Answer: A discharge refers to releasing the patient from the hospital after his treatment at the hospital is determined to be complete. A discharge also may refer to a scenario in which the patient dies in the hospital. An acute care transfer occurs when the patient is transferred from one acute care IPPS hospital to another IPPS hospital for further related care. You may use a patient discharge code 02 (Discharged/transferred to other short term general hospital for inpatient care) here. If the patient leaves the hospital against medical advice but gets admitted in another IPPS hospital, consider this as an acute care transfer with patient discharge status code 07 (Left against medical advice or discontinued care).

Research Billing Compliance Tip

Do not bill insurance or the subject for any item or service that the informed consent form (ICF) says will be provided by the study or sponsor. If the patient signed a consent that says “this test will be paid for by the study,” even if the language was written in the consent in error, it must be adhered to.

More Billing Compliance Tips can be found at www.obc.med.miami.edu.

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