Reimbursement: Know Your Patients' Payers to Capture Legitimate Post-Op Revenue

Why This Topic Matters

Postoperative complication claims can be bundled by one payer and separately reportable by another, so understanding payer rules helps reduce denials and avoid incorrect billing. The article also highlights why modifier selection and documentation of payer policy matter when care occurs during a surgical global period.

Article Sections

1. Tip 1: Divide Your Medicare and Non-Medicare Patients

   This section compares general Medicare/CMS and non-Medicare approaches to postoperative complication claims during the global period. It also discusses the importance of checking payer-specific policies before billing.

2. Tip 2: Decide on the Best Modifier Usage

   This section covers general modifier use for reporting postoperative infection treatment when claims are filed with different payers. It focuses on how modifiers are discussed in the context of operating room return and claim reporting.

3. 2 Examples Guide How to Handle the Situation

   This section presents illustrative billing scenarios related to postoperative infection care and how they are discussed under different payer approaches. It includes example claim situations involving hospital care and a procedure performed in the operating room.