Physician Practice

Draw up a date-of-service primer for imaging, E/M services to get paid

Physician Practice Insider, September 18, 2017

Clarify the date-of-service rules you follow for reporting common services and you’ll overcome a common pitfall linked to revenue-draining claims rejections.

Practices continue to express concerns about prevailing date-of-service requirements, with some services creating more of an uphill battle than others, notes a Medicare administrative contractor (MAC) provider outreach and education (POE) transmittal published in July that attempts to alleviate the confusion.

“This is a great update,” exclaims Margie Scalley Vaught, CPC, a coding and billing consultant based in Chehalis, Wash. Because correct date-of-service policy can fluctuate depending on the type of code you’re reporting, you may find it helpful to ascribe billing rules for certain common types of services. Adopt the following service-specific rules and regulations to get into the clear.

Radioing radiography: Come in, please

You won’t find a single, CMS-endorsed policy highlighting the correct date of service for a physician’s interpretation of an imaging code, such as an MRI or X-ray. Instead, your local payers, including MACs, likely have a stated requirement — for example, some payers may require the professional component of the imaging service to include the date of service of the test date rather than the interpretation date.

Yet some under-the-radar policy updates may leave your head spinning. For example, on July 21, Novitas, a MAC covering 14 states, revised its date-of-service policy for medical imaging professionals, stating that “many providers prefer to submit a claim with a date of service that reflects the day the professional component was performed, while others prefer to use the date of the technical component.”

That change came as a direct result of advocacy by the American College of Radiology (ACR), which seeks a more flexible date-of-service policy from payers, notes Anita McGlothlin, economics and health policy analyst with ACR, Reston, Va.

Therefore, Novitas “will leave which date of service is billed for the professional component up to the provider.” That is, providers in Novitas’ jurisdiction can report the professional component on either the date the test was performed or the date the physician interpreted the results. Remember that you’re required to submit the claim with modifier 26 (Professional component) when reporting on a separate date.

Noridian, which covers California and a dozen other states, has a similar policy, stating that it maintains a “standard of leaving which date of service is billed for the professional component up to the provider.”

Example: A patient undergoes an MRI on Thursday, but the radiologist doesn’t interpret the results until Monday. For payers that allow you to report the date of service as the interpretation date, you can submit the Monday date with modifier 26. “But there needs to be some linkage [in your documentation] that the exam was actually performed on Thursday,” cautions Vaught. For instance, you should reference the original test date in your notes, guides Vaught.

To stay in the clear with your payers, obtain written documentation about date-of-service rules from your MACs, as well as private payers. To make things easier for you, defer to one standard reporting method for all payers — whenever possible — suggests Maxine Lewis, president of Medical Coding and Reimbursement, Cincinnati. For example, stick to the thinking that “the date of service is the date the services are concluded,” guides Lewis. “This is a good rule of thumb.”

For more examples including pathology and E/M services, find the full article published in Part B News.

 

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