Question

what does the government payers or insurance carriers perform when an unusual billing pattern has been observed​

Answer 1

Whenever there is an unusual billing government payers or insurance carriers perform routine audits.

Examples of unusual billing patterns include but are not to:

1. the serial reoccurrence of the same diagnostic code after every visit;
2. the repeated billing of the same procedure.

These audits are performed using, in most cases, computer software applications which are capable of screening transactions to uncover such patterns.

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