Avoiding Medicare fraud. Part 1.
In 1997, Congress authorized payments to nurse practitioners (NPs) for Medicare-provided services. NP services are now reimbursed at 85% of the physician fee schedule. As this source of reimbursement was realized, so was a new area of liability for NPs. Failure to follow billing rules can result in payment denial, repayment of fees already paid, mandated educational activities, fines, fraud prosecution, loss of Medicare-billing ability, and loss of employment. Appropriate billing entails adhering to guidelines for selecting procedure codes and proper medical documentation. This article identifies high-risk areas for NPs who bill Medicare and provides resources for accessing additional information.
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D005568:Forms and Records Control; D005607:Fraud / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D006801:Humans; D007344:Insurance Claim Reporting / Q000331:legislation & jurisprudence*; D007355:Insurance, Nursing Services / Q000331:legislation & jurisprudence*; D016365:Liability, Legal; D006278:Medicare / Q000331:legislation & jurisprudence* / Q000592:standards; D009722:Nurse Practitioners; D011216:Practice Management, Medical; D014481:United States