When and how to use this modifier appropriately, that is the question. Surgeons work hard, so when they perform beyond the “typical” hernia repair or the not-so-usual third meniscal repair, a higher reimbursement is warranted. Appending modifier 22 Increased procedural services to the surgical code tells the payer the surgeon went above and beyond the ...
In Billing
May 23rd, 2019
Beginning July 2019, oncologists who are part of the Center for Medicare & Medicaid Services’ (CMS) voluntary Oncology Care Model (OCM) who haven’t achieved a performance-based payment (PBP) will be switched from a 1-sided risk model to a 2-sided risk model.   According to an Avalere study, half of those being switched will lose money. Avalere advises ...
In Audit
May 14th, 2019
If you want to smooth reimbursement claims for durable medical equipment, CGS offers 28 documentation checklists that identify what must be included. Recently updated, these checklists include the following items and services: Enteral nutrition Glucose monitors and supplies Hospital beds and accessories Immunosuppressive drugs Large volume nebulizers and inhalation drugs Lower limb prostheses Manua...
In Billing
May 10th, 2019
If your provider is ordering nebulizers and the drugs used in them for their patients, here are things  in the documentation that will help prevent a resubmission to Medicare and ease medical coding. CMS Wants Nebulizer Necessity The Centers for Medicare & Medicaid Services (CMS) recently released an MLN fact sheet that helps clarify what’s ...
In Billing
Mar 4th, 2019
Be sure you are familiar with the identifier codes of drugs and vaccines, and their rules, when billing drug products. The National Drug Code (NDC) number is a universal product identifier for drugs used in the United States. The Center for Medicare & Medicaid Services (CMS) has required NDC numbers to be reported when submitting ...