I am fan of attorney Knicole Emanuel’s blog and this one is worth the read. We are being audited to death while the Medicare Advantage (MA) plans deny medically necessary care. That’s why I call it “Medicare Disadvantage.”
“Maybe it’s time to switch our telescopic lens from auditing providers to auditing MCOs and MAs. Let’s get these RAC, ZPIC, and TPE auditors focused on the stewards of our tax dollars, the prepaid entities.”
It is important to know if the patient is in the hospital under “observation” status or “inpatient” status because this affects CPT® code selection.