E/M / Provider News

E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310

87 percent error rate leads to drastic measures. If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings. NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it [...] Related articles:

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  3. CMS Will Offer New Modifier to Denote Admitting Physician on ClaimsPop the champagne cork & get ready for brand new...

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February 2, 2010
Audit / Hot Coding Topics / MAC / modifier 58 / modifier 78 / modifier 79

Global Billing: Document ‘Unrelated’ for Modifier 79 Services

MACs are looking for ‘red flags’ to halt additional global period pay Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims. After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt [...] Related articles:

  1. These 8 Services Are Not Part Of The Global Surgical PackageIf you’re not reporting these services separately, you’re losing money....
  2. Modifier Cheat Sheet: Banish Your E/M Modifier Phobias ForeverOnce you have this tool, you’ll never again wonder which...
  3. Bone Up On ASC Orthopedic Coding With These Global Period, Modifier Tips 3 ways your physician claim better look different than...

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January 7, 2010