PPT-A Discussion on Modifier PO, Medical Necessity Claim Denial

MAPAM September 15 2016 Todays Presenters Jeanine Gombos LPN CPC Provider Outreach amp Education Consultant Medicare Part A 2 Disclaimer National Government Services Inc has produced this material as an informational reference for providers furnishing services in our contract jurisdiction National Government Services employees agents and staff make no representation warranty or guarantee that this compilation of Medicare information is errorfree and will bear no responsibility or liability for the results or consequences of the use of this material Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication the Medicare Program is constantly changing and it is the responsibility of each provider to remain abreast of the Medicare Program requirements Any regulations policies andor guidelines cited in this publication are subject to change without further notice Current Medicare regulations can be found on the CMS website at . Modifier 51 Multiple Procedures:use Modifier 51to indicate that multiple procedures (other than E/M) were performed at the same session Use modifier 51 on the second and subsequent operative procedure Manager. of Revenue Cycle. Recovery Audit. Wheaton Franciscan Healthcare. FISS Best Practice. Is your hospital leaving money on the table?. Objectives. 1.) Search for claims that the Fiscal Intermediary has pulled for review or denied.. Sustaining a Financially Healthy . Critical Access Hospital. June 15, 2015. Agenda. Critical Access Hospital (“CAH”) and PPS Hospitals. CAH Payments. IP Admissions. Reasonable Cost Payment Principles That . Glenn Krauss, BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, . C-CDI. Manager. Accretive Health. Medical Necessity. Medical Necessity . Fundamental to Medicine. Integral to Revenue Cycle. Basis for healthcare delivery transformation. Helping You Sleep Better at . Night. Presentation to. N.W. Ohio HFMA. August 29, 2012. Jim McCauley, . Vice President, EDI Services. Increase Cash Flow….Drive Revenue Cycle Efficiencies….Reduce Bad Debt ….. Jason Hess, LCAC. Executive Director. Heartland RADAC. How do I get those darned insurance companies to listen?!?. Alternative Title. 4 Essential Elements . to Good Counseling. WEG +. W. armth – Caring, Supportive, Welcoming. By Melissa Blank-. Harbert. , Vice President &. Nancy Binder, Executive Director. Denials. Documentation is key to Denial Prevention. Denial Prevention – Best Practice . Agenda:. Denial Reasons / Root . Let’s get this right!. Julie Hall, Director. Jon Menard, Manager MAPAM Meeting. Consulting Division April 20, 2017. Why are Modifiers Needed? . Modifiers provide additional information in relation to how the procedure was performed, where the procedure was performed and why the procedure was performed.. Associate Director, WSMA Practice Resource Center. Michelle M. Lott, CPC, CPMA . Health Insurance Coding Specialist, WSMA . Phone: 206.441.9762. 800.552.0612. Fax: 206.441.5863. Email: mml@wsma.org. An Overview of Key . C. omponents. Presented by . BHM Healthcare Solutions. Learning Objectives. Upon completion of this presentation participants will have a thorough knowledge of Medical Necessity Criteria including emerging definitions. Jason Hess, LCAC. Executive Director. Heartland RADAC. How do I get those darned insurance companies to listen?!?. Alternative Title. 4 Essential Elements . to Good Counseling. WEG . W. armth – Caring, Supportive, Welcoming. page 1 of 8Determination for Bariatric Surgery31ese Guidelines for Medical Necessity Determination 147Guidelines148 identify the clinical information that MassHealth needs to determine medical necessi Description When to use the GY modifier Examples of its use What happens if you use the GY modifier? What happens if you don't use the GY modifier? These are the so-called "statutory exclusions" in Denials . May 17, 2023. Agenda. 1. 2. 3. 4. Denials Increasing Across the Country. Issue Identification. Rules and Rationales . Analysis and Application. 5. Conclusion. Today’s Clinical Denials Landscape.