Hello all,
I'm currently coming across several denials for global billing in the ASC. This is specific to Medicare Advantage Plans in the ASC. Per CMS guidelines any Medicare Advantage facility claims must be billed on a HCFA-1500 instead of the traditional UB04. I've had several instances where the 93458(TC) is being denied but the 93458(26) is being paid. Denial states: Services billed with Modifier TC on a professional claim with a facility place of service are included in the facility reimbursement. I've also attached a copy of Cigna's policy guideline regarding global billing. Please help me understand what needs to be done to get these claims paid. Thanks in advance!
I'm currently coming across several denials for global billing in the ASC. This is specific to Medicare Advantage Plans in the ASC. Per CMS guidelines any Medicare Advantage facility claims must be billed on a HCFA-1500 instead of the traditional UB04. I've had several instances where the 93458(TC) is being denied but the 93458(26) is being paid. Denial states: Services billed with Modifier TC on a professional claim with a facility place of service are included in the facility reimbursement. I've also attached a copy of Cigna's policy guideline regarding global billing. Please help me understand what needs to be done to get these claims paid. Thanks in advance!