This week’s updates include identifying "No Documentation" medical necessity denials for claims flagged for Recovery Auditor review; Shared System Enhancement 2015 Analysis and Design HUOPCUT hospice period and Health Maintenance Organization processing; and more!
Q: If we're not using condition code W2 but we're billing on the type of bill (TOB) 121 after we received a denial, are we paid less than if the W2 would have been used?
Three years after publishing a notice of public rulemaking requiring hospitals to report Medicare overpayments to CMS, the agency finalized a rule that makes significant concessions to providers, but still requires a six-year lookback period.
The government may finally have to comply with its congressionally mandated deadlines for reviewing claims at the Administrative Law Judge level after a federal appeals court this week reversed a lower court’s dismissal of a lawsuit brought by hospitals.
Q: I was at a conference last week and while we were on a break, I heard someone say that we don’t have to use modifier -L1 (separately payable laboratory test) to get paid for lab work from Medicare. Is that true?
Q: Does the concurrence of the attending physician, that is required for condition code 44, need to be recorded by the attending physician, or can another practitioner write the concurrence
