Revenue Cycle

Region D RAC approved to audit modifiers -TC and -26, adds DME issue

Recovery Auditor Report, November 25, 2009

HealthDataInsights (HDI) has been approved by CMS to audit for inappropriate billing related to the use of modifiers -TC and -26 on Part B claims in all RAC Region D states.
The new issue is as follows:
  • 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.
In addition, HDI added another new issue approved for DME claim audits: DMEPOS while patient is in a covered Part A inpatient hospital stay.
The Web site provides the following explanation of the new issue:
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.
To see an updated list of issues approved in your area, visit the Tools section of the Revenue Cycle Institute Web site, and download our chart of approved RAC issues.

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