Find-A-Code Focus Newsletter

$4.6 million in Claims Paid Incorrectly by CMS when Using KX Modifier

January 22, 2018

$4.6 Million was paid by CMS for claims that did not comply with Medicare requirements.  The claims were paid in 2017 and reported by the Office of Inspector General (OIG) stating, "A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements". 

The KX modifier is used to report correct documentation is on file, this modifier should be used in the context of the claim, indicating that the provider or supplier has ensured coverage criteria for the product or service has been met and documentation exists to support the medical necessity.    

KX - SPECIFIC REQUIRED DOCUMENTATION ON FILE

Be sure you are using this modifier correctly, clarify the usage of the following documents. 

References:

share
 

More Items in January 2018


To view more items select a month from our "Items by Month" list.

Or view documentation, coding and billing articles.

 
News Items by Month
February 2022- 1
2021 - View
2020 - View
2019 - View
2018 - View
2017 - View
2016 - View
2015 - View
2014 - View
2013 - View
2012 - View
2011 - View
2010 - View
2009 - View
2008 - View
demo
request yours today
subscribe
start today
newsletter
free subscription

Thank you for choosing Find-A-Code, please Sign In to remove ads.