tci Medicare Compliance & Reimbursement - 2010 Issue 2
CONSULT ELIMINATION: New Modifier AI Allows Multiple Docs to Bill Initial Hospital Care
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Article Overview
This article covers a CMS policy change affecting inpatient and nursing facility evaluation and management billing after the end of consultation reimbursement. It is aimed at coders, billing staff, and physicians who need to understand the general impact of modifier AI, initial care reporting, and the transition away from consult coding under Medicare and potentially other payers.
Why This Topic Matters
The change affects how multiple physicians may report initial hospital or nursing facility care and how claims are identified under Medicare policy. It is important for keeping inpatient professional billing aligned with payer requirements during the transition away from consult-based reporting.
What You Will Learn
- How CMS changed reporting for hospital and nursing facility evaluation and management services
- Why modifier AI was introduced in connection with the policy change
- How the shift away from consultation reimbursement affects initial care reporting
- Why billing practices may differ across payers
Who Should Read This
- Medical coders
- Billing staff
- Compliance staff
- Physicians
- Hospital revenue cycle teams
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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