- Q&A: Authentication is key to establishing medical necessity
Q: We received a denial for services based on medical necessity. A Comprehensive Error Rate Testing (CERT) auditor reviewed our laboratory services claim against the medical record documentation and denied the services for lack of medical necessity. We submitted the medical record documentation, which consisted of the lab requisition and the lab results. The diagnosis on the requisition was a covered diagnosis and dates of service on the claim and the test results matched. We don’t know why we received this denial.
- Help stop unnecessary or duplicate tests
Are your organization’s docs ordering too many tests? It’s possible, according to recent statistics, which estimate that unneeded and unnecessary medical interventions cost the U.S. healthcare system some $210 billion each year.
- Q&A: Can we still use modifier -JF?
Q: What happened to modifier –JF (compounded drug)? CMS added it in April, but I’ve been told by our billing department that it’s been removed.
- JAMA opinion piece urges modifications to Readmission Reduction Program
Safety-net hospitals are unfairly penalized by CMS’ Hospital Readmission Reduction Program, according to an opinion piece in the July 28 issue of the Journal of the American Medical Association.
- Q&A: How do we report alemtuzumab?
Q: Our physicians want to administer a drug that’s new to us called alemtuzumab, with the brand name Lemtrada®. However, we found no information concerning a HCPCS code for reporting this drug. How can we bill Medicare?
- What's the difference? Advance Directive versus POLST
Do you know the difference between an Advance Directive and a Physician Orders for Life Sustaining Treatment form?