decisionhealth Newsletters, Part B News - 2009 Issue 12 (December)
CMS unveils modifier ‘AI' for use after consults are eliminated
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Article Overview
This article covers CMS guidance on inpatient and nursing facility E/M billing in the context of Medicare consult payment ending, including the introduction of a new modifier and related transmittal-based instructions. It is relevant to hospital coders, physician billing staff, and compliance teams who need to understand the general framework of the policy change, the affected service categories, and where CMS says to look for further carrier direction.
Why This Topic Matters
The piece helps readers track a Medicare policy shift that affects how inpatient and nursing facility visits are reported when more than one provider sees the patient during an admission. It matters because it points to a new modifier, changing consult-related billing practices, and the need to follow carrier-specific instructions.
What You Will Learn
- How CMS framed the end of Medicare consult payment and the resulting billing impact
- What types of inpatient and facility-based E/M services are affected by the policy change
- How CMS says providers should look to carriers for additional billing direction
- What role documentation plays in supporting the reported admitting or attending physician
- How the policy change affects follow-up facility visits and other providers' claims
Who Should Read This
- Medical coders
- Hospital billing staff
- Physician practice billers
- Compliance auditors
- Revenue cycle managers
Modifiers Discussed
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