If Medicare determines that an E/M service exceeds the patient's documented need, Medicare could:
A) unbundle the service.
B) upcode the service.
C) pay the service as billed.
D) deny payment.

Question

Quizplus · Accepted Answer

If Medicare determines that an E/M service exceeds the patient's documented need, it may deny payment for that service. Medicare only reimburses for services that are deemed reasonable and necessary for the diagnosis and treatment of a patient's medical condition. If the service was not needed or was excessive, Medicare will not pay for it. Unbundling or upcoding the service would not be appropriate in this situation.

If Medicare Determines That an E/M Service Exceeds the Patient's