Find-A-Code Focus Newsletter

2018 January Items

MAC Operations Continue During Shutdown

January 23, 2018
CMS announced today, during the time that the partial government shutdown is in effect, Medicare Administrative Contractors will continue to perform all functions related to Medicare fee-for-service claims processing and payment.... Read More

UCR Pricing, What is it?

January 22, 2018
UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location.  Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment refer... Read More

$4.6 million in Claims Paid Incorrectly by CMS when Using KX Modifier

January 22, 2018
$4.6 Million was paid by CMS for claims that did not comply with Medicare requirements.  The claims were paid in 2017 and reported by the Office of Inspector General (OIG) stating, "A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed... Read More

New Payment Model launched by CMS- Bundled Payments for Care Improvement Advanced (BPCI Advanced).

January 22, 2018
In an effort to move away from Fee-For-Service and towards paying for Value, CMS launched a new payment model, “Bundled Payments for Care Improvement Advanced (BPCI Advanced)”. This is a voluntary bundled payment model where providers get paid for each individual service they perform. C... Read More

Should ROM Testing be Reported with Evaluation and Management Services?

January 22, 2018
We recently received an email from a reader asking whether or not range of motion (ROM) testing (95851-95852) using a duel computerized inclinometer with a separate report when done at the same time as an Evaluation and Management (E/M) services, could be billed if reported with modifier 59&n... Read More

NEW on Find-A-Code: National Coverage Determinations (NCDs)

January 22, 2018
Medicare limits its coverage of services to those considered reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, and public participation, and m... Read More

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