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tci Medicare Compliance & Reimbursement - 2013 Issue 1

Payer Preferences: You Could Be Missing Out On Legitimate Post-Op Revenue

Don’t automatically skip billing for post-surgical infection care. If you’re pondering whether services for a post-op complication are included or are reported separately, you’ll benefit from two tips about when you should bill for post-op care. Tip 1: Distinguish Between Medicare and Non-Medicare Patients Medicare treats postoperative complications, including infections, differently than insurers who follow CPT® guidelines. Although both CMS (Medicare) and CPT® guidelines indicate that the global surgical package includes "typical" postsurgical care, the two sources differ regarding what qualifies as typical -- which means you must differentiate your claims depending on which payer you...

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