Medicare Compliance & Reimbursement
Are Your State's Critical Care Stats Above Average? Find Out
Warning: Critical care is on most MACs’ Targeted Probe and Educate active lists. Benchmarking allows you to check your numbers, ensuring your practice claims are in line with federal standards. If you’re worried about your critical care service claims, you may want to survey your billing rates against those of other providers in your state to get a gauge of where you fit in. Here’s why: Currently, critical care CPT® codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) are under Targeted Probe and Educate (TPE) medical review for Part B MACs who’ve published their active lists like CGS Medicare, Novitas Solutions, and Palmetto GBA. RAC & CERT: In addition, there are three separate issues that Recovery Audit Contractors (RACs) are targeting: excessive units of the initial E/M code 99291; critical care services billed on the same day as an emergency room (ER) visit; and the unbundling of critical care. And as if that’s not enough, critical care services also ranked in the top 20 on last year’s Medicare Fee-for-Service Supplemental Improper Payment Data Report with a 19.1 improper payment rate and accounted for $184 million in improper payments — with claims data compiled and reviewed by Comprehensive Error Rate Testing (CERT) auditors. With the heightened scrutiny, it’s vital for you to rein in unnecessary visits or make sure your documentation is bulletproof for those visits that are valid before your claims get pulled for medical review. See if your state’s allowed charge rates transcended the national average of $464.00 last year: *Data from Palmetto GBA/eGlobalTech CBR 201804: CBR201804 Average Allowed Charges per Beneficiary.xls.
Medicare Compliance & Reimbursement
- Part B Statistics:
Measure Your Critical Care Numbers Against Other Providers'
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