Quote:
Originally Posted by Pessemist
The questionable billing has caught up a lot of providers across the country including myself at one point.
What Medicare did awhile back to save money was to ‘bundle’ a bunch of services, with their own unique CPT codes, that were usually performed together into a single ‘bundled’ code with its own CPT code.
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It is not Medicare who caught on to the shady way providers billed everything as a separate procedure. Definitions of services have always prohibited unbundling. And the definitions of CPTs are not created by Medicare (CMS) rather they originated with the AMA in the 1960s. So it was physicians themselves who wrote the rules against unbundling. CMS uses the AMA criteria and codes.
By the way there is zero evidence that unbundling is what got TVH in trouble. Rather it seems to be upcoding the intensity of services by creating the appearance of a sicker panel of patients which resulted in a higher payment rate. I don't know this for a fact. I'm just reading between the lines of the reports I've seen to date.
The Villages Health Bankruptcy: What Went Wrong and What We Can Learn - Taino Consultants.