Life Care Planners
News and Important Information
Coding with PCS When There is No Code
VA-UCR Prof Services Modifier Charge Factor
Newest Launch - We Now Have Outpatient Facility Pricing!
Tools and Resources for Life Care Planners
Spinal Cord Stimulator Used for Chronic Pain
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Resources
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Are NCCI Edits and Modifiers Just for Medicare?
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Understanding UCR Inpatient Fees used on DRGs
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Outpatient Facility Pricing
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Spinal Cord Stimulator Used for Chronic Pain
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Tools and Resources for Life Care Planners
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Anesthesia and Fee Calculation
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Links and resources by topic.
Compliance (2022-06-16)
Implanted Spinal Neurostimulators: Document Medical Records
In a recent report, the Office of Inspector General found that Medicare improperly paid claims for implanted spinal neurostimulators when providers didn’t provide sufficient documentation supporting medical necessity. For dates of service on or after July 1, 2021, you must ask your Medicare Administrative Contractor to authorize these services before performing the procedure in the hospital outpatient department.
Learn what you need to include in patient medical records:
- Prior Authorization and Pre-Claim Review Initiatives webpage
- Section XVII Calendar Year 2021 Hospital Outpatient Prospective Payment System final rule
- Section 6.3.2.2 Prior Authorization Program for Certain Hospital Outpatient Department Services (PDF) operational guide
- 2021 Final List of Outpatient Department Services That Require Prior Authorization (PDF)
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