Medicare Compliance & Reimbursement

Get your rightful reimbursement for scores of services with these 5 pointers. Medicare coding rules are complex and challenging, and sometimes it’s hard to know which services you can rightfully bill. But if you’re up to speed on these key billing practices, you’ll be raking in deserved pay: 1. Mine those modifier 59 opportunities. Some coders assume that if the Correct Coding Initiative (CCI) forbids billing two codes on the same date, that’s the end of the story. But in fact, you may be missing out on some legitimate cases where CCI allows you to use modifier 59 (Distinct procedural service) to override an edit. Always scan the CCI edits to see which code pairs a modifier can override. Of course, you should only use the 59 modifier when the services are separate, distinct, and medically necessary. 2. Collect copays at the visit. You’ll save yourself time and money later [...]