Region D RAC approved to audit modifiers -TC and -26, adds DME issue
Recovery Auditor Report, November 25, 2009
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- Global vs. TC/PC. An overpayment exists when providers are reimbursed for global procedures and then receive additional reimbursement for technical (modifier TC) and/or professional (modifier 26) components for the same service.
For a beneficiary in a Part A inpatient stay, an institutional provider (e.g., hospital) is not defined as a beneficiary’s home for DMEPOS: Medicare does not make separate payment for DMEPOS when a beneficiary is in the institution. The institution is expected to provide all medically necessary DMEPOS during a beneficiary’s covered Part A stay. The overpayment is DMEPOS items provided during a Medicare Part A covered inpatient stay.
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