"Unbundling" refers to the practice of submitting individual bills for separate tests that should be bundled together into a single bill for a group of related tests.The amount allowed under Medicare for this "bundled" amount is considerably lower than the sum of the amount for tests billed separately.
"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media.
Eliminating healthcare fraud and abuse has become a top priority for the federal government.
An approach will be developed to identify facilities that are potentially engaged in inappropriate coding for more thorough review and proper remedial action.
Approaches may include the use of changes in case mix or commercial software currently used to detect billing irregularities.
This project will assess whether physicians are correctly coding evaluation and management services in locations other than teaching hospitals and whether carriers are adequately monitoring physician coding.
Previous work by the OIG has found that physicians are not accurately or uniformly using visit codes.
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What can you do to reduce the chance of your employer becoming a target of a fraud investigation related to coding, or if you do become a target, minimize the risk of assessment of maximum penalties?
How can you assure and demonstrate that your organization has accurate, ethical coding practices and medical record documentation that supports the diagnoses and services reported on the claim for reimbursement?
This initiative is being undertaken as a result of the OIG's audit work in this area -- which suggested that many providers were not in compliance with the applicable Medicare reimbursement policies.