Improperly billing for consultation services Sample Clauses

Improperly billing for consultation services. The CPT codes for consultation services typically reimburse at a higher rate than the codes for other evaluation and management office visit codes. CPT code 99245 reimburses at the highest level for the consultation codes, and physicians typically spend 80 minutes face-to-face time with the patient and/or family. The requirements for HCA to properly xxxx XXXXX XXXXX’x services for a consultation included: (a) another physician or other appropriate source had to request XXXXX XXXXX’x opinion or advice regarding evaluation and/or management of a specific problem; and (b) XXXXX XXXXX’x opinion and any services that were ordered or performed had to be documented in the patient’s medical record and communicated by written report to the requesting physician or other appropriate source. Defendants submitted claims for consultation services purportedly provided by XXXXX XXXXX when, in fact, no physician or other appropriate source had requested her opinion or advice regarding evaluation and/or management of a specific problem, and XXXXX XXXXX’x opinion and services that were ordered or performed were not communicated by written report to the requesting physician or other appropriate source.
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