CMS

“I am part of a recovery audit from CMS for using a modifier 59. Cotiviti Healthcare has been hired by CMS to review my use of modifier 59. They stated that my operative report supports documented Charcot reconstruction and the use of application of external fixator (CPT 20692) but modifier 59 was inappropriately used since both procedures were performed at the same session. Should I have used a different modifier in this situation? Is application of an external fixator (CPT 20692) not considered a separate procedure if it is performed at the same session as other reconstruction procedures?"

“Our office has decided to take the leap and do diabetic shoes for patients who see a Nurse Practitioner or a Physician’s Assistant. Has anyone had any luck with this? We are noticing that we are not hearing much about this since earlier this year.”

The net result is a decrease in payments of 3.89%. How does this break down?

Beginning in 2022, if you order Medicare Part B advanced diagnostic imaging services, you must consult appropriate use criteria (AUC) through a qualified Clinical Decision Support Mechanism (CDSM). You must also provide the information to furnishing professionals and facilities, because they must report AUC consultation information on their Medicare claims. When we use “you”, we are referring to physicians, other practitioners, and facilities ordering advanced diagnostic imaging services and/or furnishing Part B advanced diagnostic imaging services to Medicare beneficiaries and billing Medicare Administrative Contractors (MACs).

TLD Systems has sponsored on Demand Webinars at CME Online

CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.

Medicare has released updated articles to reflect the annual ICD-10 update. These updates are effective on October 1 and change the coding and documentation requirement for many services we provide.

Upcoming and Recorded CMS Trainings

CMS launched Care Compare, a streamlined redesign of eight existing CMS health care compare tools available on Medicare.gov. Medicare has just announced that it will expand the requirements for prior authorization for ambulance transport for “Repetitive, Scheduled Non-Emergent Ambulance Transport.”