tci Medicare Compliance & Reimbursement - 2014 Issue 12

Compliance: Try This When Anesthesiologist Doesn't Quite Meet All Criteria

Hint: Final determination of what constitutes medical direction can vary. When your anesthesiologist hasn’t met all seven criteria required to report his services as medical direction, this “incomplete” medical direction can present coding challenges. One key is knowing when to use which modifier to avert a claim denial. Let these three expert tips guide your way. 1. Start With Your Local Carrier The Centers for Medicare and Medicaid Services (CMS) does not have a national-level policy for incomplete medical direction. Instead, it has directed the local carriers to address this issue case by case. That means the...

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