In Billing
Feb 25th, 2019
The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative ...
Sep 11th, 2018
Scrubbing is the best way to ensure your claims are clean of unbundling overpayments. A hospital finance department should not treat National Correct Coding Initiative (NCCI) edits as irrelevant to inpatient billing simply because payers don’t use the NCCI to edit inpatient claims before payment. Instead, hospitals should institute internal controls to ensure claims are ...
Modifier L1 Separately payable lab test was implemented in 2014 by the Centers for Medicare & Medicaid Services (CMS) as part of the July Outpatient Prospective Payment System (OPPS) package updates (CMS 2014). Under the 2014 OPPS packaging edits, if a laboratory service with status indicator A Services furnished to a hospital outpatient that are ...
If appropriate rules and system edits are in place, exclusionary modifiers are the link to unbundling liability. Unbundling is a commonly asserted but often misunderstood fraud theory, even by coding experts. When evaluating potential unbundling as a fraud theory, it’s important to differentiate when separate reporting of services is simply correct coding and when it ...
In Audit
Oct 15th, 2014
Coders learn early and are reminded often to avoid unbundling, or separately reporting procedures/services that are meant to be reported together, using a single code. As the introduction of the National Correct Coding Initiative (NCCI) Policy Manual explains, “Procedures should be reported with the most comprehensive CPT® code that describes the services performed.” To make ...