In Audit
Feb 21st, 2018
Medical claims for off-the-shelf orthotic devices have nearly doubled in the past several years, which has attracted the attention of the Department of Health and Human Services (HSS) Office of Inspector General (OIG). As part of its ongoing Work Plan, the OIG intends to examine claims to be sure that Medicare beneficiaries are receiving a ...
Feb 21st, 2018
Sometimes coders are confused when they should apply modifier 58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period and modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure ...
In Audit
Feb 20th, 2018
A specimen validity test performed on the same day as a urine drug test for the same person should be a rare occurrence because specimen validity testing is included in the description of HCPCS Level II codes for urine drug tests. Billing both tests separately is like double-dipping. And yet, Medicare paid 4,180 clinical laboratories and physician offices ...
In Billing
Feb 19th, 2018
Effective Jan. 1, 2018, newly approved biosimilar biologicals with a common reference product are no longer grouped into the same billing code. This change was finalized in the 2018 Medicare Physician Fee Schedule final rule. Q5102 Replaced with Two New Codes The April 2018 update to the Medicare Physician Fee Schedule Database (MPFSD) includes three ...
In Billing
Feb 16th, 2018
It may sound like something out of a sci-fi movie, but hyperbaric oxygen (HBO) therapy is real. It involves breathing pure oxygen in a pressurized room or tube, and it has long been used to treat decompression sickness from scuba diving. More recently, physicians have found it useful to treat other conditions. Medicare Coverage under ...