Revenue integrity professionals often run across tough questions. On the NAHRI Forums, revenue integrity professionals can get advice from peers and experts and learn about solutions others have discovered. Here are the questions that have sparked the most conversation.
Q: When a physician schedules a procedure, do you evaluate the patient’s record prior to the procedure to determine whether all of the coverage requirements of the applicable National Coverage Determinations and/or Local Coverage Determinations are met?
Q: Over the last few weeks, there have been quite a few articles in various newsletters about device credits. I’m not sure we have the best process in place to identify recalls and under-warranty replacements so I took a look. In the first account I reviewed, I found an item from a St. Jude recall. When I shared my findings with my compliance officer, the response was, “Why are you looking?” Should I not look?
Q: Are outpatient departments considered part of the therapy cap for hospital-owned facilities? If so, do we need to bill with modifier –KX (Type of Bill 012X)? I want to ensure I’m billing correctly.
Q: Can a hospital bill for orthotic or prosthetic supplies (e.g., leg brace for a patient in the ED or clinic) on the hospital claim? What are the requirements for billing these supplies? Is revenue code 0274 the correct revenue code? Are HCPCS codes needed?
