Q&A: You’ve got questions! We’ve got answers!
Physician Practice Insider, April 4, 2017
Submit your questions to Editor Nicole Votta at nvotta@hcpro.com and we will work with our experts to provide you with the information you need.
Q: Do the -PO and -PN modifiers apply to Medicare Advantage?
A: The -PO and -PN modifiers are just modifiers that describe particular situations. Some of the Advantage plans will accept modifier -PO but it makes no payment difference. It’s up to the discretion of the plan.
Modifier -PN, arguably, would not apply to an Advantage plan. However, if you have a non-contracted Advantage plan, which would pay the Medicare rate, you would have to report it so they could calculate the rate correctly. In other words, modifier -PN is a rate modifier. It sets a rate. Contracted Medicare Advantage plans set their own rates; therefore, modifier -PN wouldn’t apply to contracted Medicare Advantage plans. However, when you have non-contracted plans, the non-contracted plans have the option of using the Medicare rate. They would not be able to correctly determine the Medicare rate without modifier -PN.
Editor’s note: This question was answered by Kimberly Anderwood Hoy Baker, JD, CPC, director of Medicare and Compliance for HCPro, a division of H3.Group, in Middleton, Massachusetts. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Opinions expressed are those of the author and do not represent HCPro or ACDIS. Email your questions to Editor Nicole Votta at nvotta@hcpro.com.
Related Products
-
Physician Practice Perspective
Physician Practice Perspective subscribers can find the archive of issues on the Part B News website. Find more information...
-
Medical Environment Update
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
HealthLeaders Media Physician Leaders
HealthLeaders Media Physician Leaders offers commentaries that focus on the hottest issues for doctors as well as concise...
-
Medical Environment Update - Electronic and Print, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
-
Medical Environment Update - Electronic, 1 year
A subscription to Medical Environment Update pays for itself by saving you time sorting through complex regulations and...
Most Popular
- Articles
-
- Practice the six rights of medication administration
- Don’t forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Differentiate between types of wound debridement
- OB services: Coding inside and outside of the package
- What does case-mix index mean to you?
- What to include on the incident report
- Know guidelines and subtle differences in code descriptions for laceration repairs
- What is the difference between an IPA and a medical group?
- Reimbursement for Facility and Professional Services in a Provider-Based Department by Gina M. Reese, Esq., RN
- E-mailed
-
- Joint Commission: how to improve patient depression screening and treatment
- EPA announces final rule to set new standards on hazardous waste pharmaceuticals
- Clarification: Anemia documentation and coding presents communication hazards
- Injections and infusions continue to confuse coders
- Use modifier -59 sparingly when reporting add-on codes
- HFAP unveils OPPE, FPPE requirements
- For commercial payers, is it necessary to perform a recertification visit within the required five-day window?
- Expirations on standing orders
- Are there existing standards on inactivity timeouts we can reference?
- 10 Ways to Protect Nurses From Active Shooters
- Searched