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Explanations for duplication of services in health care.

A. More than one member of the same medical practice treat the same hospitalized patient on the same day for different reasons resulting in different code modifiers.

B. Members of the same practice treat the same patient on consecutive days.

C Two emergency room physicians treat the same patient who had to be readmitted after being treated and released earlier in the day.

D. Two members of the same medical practice bill for the same patient/ inpatient services on the same day without explanatory justification.

Solution Preview

The first point I will make to help you understand this question is that (CMS) or The centers for Medicare and Medicaid have many rules on duplication of services. They do have a website that is helpful for understanding this if you are interested in further knowledge. Duplication of services can get complicated. For instance a patient presents to the Emergency Department for non-specific chest pain. An EKG is ordered and performed. The patient is later admitted to the hospital and the admitting physician orders another EKG because he did not realize one was done in the Emergency department, this EKG will not be billable as it is a duplication. Another scenario is a patient presents with chest pain that has resolved. An EKG is performed that is normal. Several hours later the patient has severe chest ...

Solution Summary

This solution gives a detailed explanation of duplication in billing of services in the health care field. The solution answers three different scenario's in a hospital setting, includes a 500 hundred word explanation. The content is original with a reference to the Centers for Medicare and Medicaid website.

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