Individual skill

claims-billing-rules

Reasoning skill for healthcare claims billing rules and fraud detection logic. Use when the user asks about CMS billing rules, place of service codes, global surgery periods, modifier usage (25 59 76 77), NCCI edit logic, column 1 column 2 code pairs, mutually exclusive procedures, modifier indicators, fraud waste and abuse patterns, E&M upcoding, unbundling, phantom billing, impossible day detection, coding error versus fraud distinction, FWA investigation methodology, or claims audit logic. Triggers include "CMS billing rules", "NCCI edits", "modifier 25", "modifier 59", "global surgery period", "upcoding", "unbundling", "phantom billing", "impossible day", "FWA", "fraud waste abuse", "coding error vs fraud", "claims audit", "billing compliance", "E&M level selection".

skills/claims-billing-rules/SKILL.md

Source commit 4603541c396cdd845dbae554800a65132d12bb63

What was checked

Matches the observed repository HEAD

Yes

Scanner rules are current

Yes

Repository scan complete

No

Skill scan complete

Yes

Observed behavior

Instructions only

Last checked

Nov 11, 2026

These are observations at the recorded commit, not a guarantee of safety. Review the source before running it.

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