Physician Practice

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.

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