Sunday, February 7, 2016

Difference Between 58 and 78 Modifier

Modifier 58, Staged or related procedure or services by the same Physician or other Qualified Health care Professional during the postoperative period.

When to Use modifier 58

Modifier 58 is used to identify those situations when a procedure or services may be staged(planned). While a return to the operating room for a related procedure
may be commonplace, a staged (planned) procedure or services may not be as routine. I will try to clarify the intent when to
exactly use modifier 58 with the procedure code. As per the CPT coding guidelines, Modifier 58 is assigned for any subsequent procedure,
Which is planned or has to be performed with the related original procedure. Following three key points should be remembered before
appending modifier 58 to the procedure codes.

Modifier 78

Unplanned return to the operating / procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period

Sunday, January 17, 2016

Secondary diagnosis is must ambulance service

Effective with services rendered October 1, 2015 and later, ALL ambulance transports require dual diagnoses.  Providers should report the primary diagnosis as the most appropriate ICD-10 code that adequately describes the patient’s medical condition at the time of transport.  In addition, a secondary diagnosis must be reported which reflects the patient’s need for the ambulance service and ambulance personnel at the time of transport.  In order for claims to be processed and paid in a timely manner it is important that claims submitted for ambulance services contain both the primary and secondary diagnosis.

Please refer to the Ambulance Local Coverage Article A54574 for a list of “suggested” ICD-10 codes that may be reported as a primary diagnosis. Please note that the list of diagnosis codes provided in A54574 is not an all-inclusive list. Other valid ICD-10 diagnoses codes that accurately describe the patient’s condition at the time of transport may be reported as a primary diagnosis.  Please refer to the Ambulance Local Coverage Determination (LCD) Policy for a list of four covered secondary diagnosis codes (Z codes).  The secondary diagnosis code should reflect why the transport is reasonable and necessary.  If the transport is not reasonable and necessary the LCD provides a non-covered Z code.
 

Saturday, January 16, 2016

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016

On Friday, December 18, 2015, President Obama signed into law the Consolidated Appropriations Act, 2016.  Section 601, Modification of Medicare Inpatient Hospital Payment Rate for Puerto Rico Hospitals modifies the payment calculation with respect to operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for discharges on or after January 1, 2016.

CMS is currently revising the Inpatient Prospective Payment System (IPPS) FY 2016 Pricer to reflect the new payment calculation requirement.  The amount of the payment with respect to the operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for inpatient hospital discharges on or after January 1, 2016, will be based on 0 percent of the applicable Puerto Rico percentage and 100 percent of the applicable Federal percentage. In addition, the IPPS FY 2016 Pricer will include conforming changes to certain FY 2016 IPPS operating rates and factors that result from the application of the new Puerto Rico hospital payment calculation requirement, which are applicable to all IPPS hospital discharges on or after January 1, 2016. We will also incorporate the revised IPPS rates into the Long-Term Care Hospital (LTCH) Pricer, as they are used for certain LTCH claims payments.

To allow sufficient time to develop and test, CMS will implement the IPPS and LTCH Pricers on April 4, 2016. Medicare Administrative Contractors (MACs) will reprocess IPPS inpatient claims from Puerto Rico and all other IPPS hospitals with a discharge date on or after January 1, 2016. The MACs will also reprocess LTCH claims with a discharge date on or after January 1, 2016, due to the impact of this change.  Puerto Rico hospitals (as well as all other IPPS and LTCH hospitals) do not need to take any action. CMS expect to reprocess claims no later than June 30, 2016.

Wednesday, January 6, 2016

Provider enrollment application fee amount for 2016

Provider Enrollment Application Fee Amount for CY 2016

On December 3, CMS issued a notice: Provider Enrollment Application Fee Amount for Calendar Year 2016 [CMS–6066–N] (http://go.usa.gov/ckj8Z). Effective January 1, 2016, the CY 2016 application fee is $554 for institutional providers that are:

Initially enrolling in the Medicare or Medicaid program or the Children's Health Insurance Program (CHIP)Revalidating their Medicare, Medicaid, or CHIP enrollmentAdding a new Medicare practice location

This fee is required with any enrollment application submitted from January 1 through December 31, 2016.

Monday, January 4, 2016

New Place of service 19

New place of service 19

Effective 1st January 2016, a new place of service 19 is available to use.

A portion of an off-compus hospital provider based department which provides diagnostic, therapeutic ( Both surgery and nonsurgical), and rehabilitation services to sick or injured persons who don't require hospitalization or institutionalization .

Monday, December 28, 2015

US Federal Holidays List 2016

US Federal Holidays list 2016

Friday, January 1New Year’s Day
Monday, January 18Birthday of Martin Luther King, Jr.
Monday, February 15*Washington’s Birthday
Monday, May 30Memorial Day
Monday, July 4Independence Day
Monday, September 5Labor Day
Monday, October 10Columbus DayFriday, November 11Veterans Day
Thursday, November 24Thanksgiving Day
Monday, December 26 Christmas Day

2016 USPS Holidays list

2016 USPS Holidays list

Friday, January 1 New Year’s Day Monday, January 18 Birthday of Martin Luther King, Jr.
Monday, February 15 Washington’s Birthday
Monday, May 30 Memorial Day
Monday, July 4 Independence Day
Monday, September 5 Labor Day
Monday, October 10 Columbus Day
Friday, November 11 Veterans Day
Thursday, November 24 Thanksgiving Day
Monday, December 26 Christmas Day