As OPPS packaging has increased, providers may be less likely to appeal claims for certain denied charges based on medically unlikely edits, since it would not increase payments. However, providers should consider appeals when services are medically necessary and appropriate, as CMS bases future payment rates on accepted claims.
With a new year underway, providers likely need to get a handle on some key new modifiers, as well as important changes to an existing modifier and the deletion of a modifier that previously raised a lot of questions and operational concerns.
This week’s Medicare updates include additional guidance on the MOON form, an NCA for leadless pacemakers, delayed implementation of the (ESRD) Interim Final Rule – Third Party Payment, and more!
Managers should not assume that they can review every guideline, every item in Coding Clinic, or every coding-related issue targeted by the Office of Inspector General or Recovery Auditor.
