Coding/Billing: The Business Side of Wound Care

Coding/Billing: The Business Side of Wound Care
Kathleen D. Schaum, MS President Kathleen D. Schaum & Associates, Inc. Office: Mobile: Coding/Billing: The Business Side of Wound Care

Objectives Review process issues that are problematic Review
Discuss frequent coding errors Discuss Recognize the importance of coverage guidelines Recognize Understand current payment regulations Understand Incorporate internal and external audits into your revenue cycle Incorporate

Disclaimer Information on coding, coverage, and payment systems is provided as a courtesy, but does not constitute a guarantee or warranty that payment will be provided. Do obtain current regulations and policies pertinent to your practice from the Medicare contractor and the private payers that process your claims.

Workbook Tab 1 Acronyms Tab 2 Presentation Tab 3 Global Surgery Booklet Tab National Average Allowable Medicare Fee Schedules Tab 5 NCCI Edit Examples Tab 5 NCCI Modifier Resource Tab 7 Targeted Probe and Educate Process

Process Issues

Reimbursement Resources

Keep Up with Coding, Coverage, and Payment Guidelines
Purchase coding books each year Sign up for your MAC’s Listserv: read pertinent updates and attend pertinent webinars Review your private payer contracts and medical policies Medicare Advantage, Private Payers, Medicaid, etc. Read and comment on draft payment system rules: read final rules and implement them by January 1 Review NCCI edit manual every October and review the quarterly updates (January, April, July, October)

Direct Supervision

Direct Supervision is Required in the Provider-Based Department (PBD) for Most Services
Physician or qualified healthcare professional (QHP) must be immediately available to furnish assistance and direction throughout the performance of the procedure Immediately available means "physically present, interruptible, and able to furnish assistance and direction throughout the performance of the procedure but without reference to any particular physical boundary." (CY 2011 OPPS Final Rule, 75 Fed. Reg , (Nov. 24, 2010) Read More Details in the Medicare Benefit Policy Manual, Chapter 6

Services Nurses Can Provide in PBDs When a Physician/ QHP is Not Immediately Available?
Application of Unna Boot Application of multi-layer compression bandage Smoking cessation services

“Incident to” Guidelines for Physician Offices
"Incident to" services must be performed under the direct supervision of the physician Services must be an integral, although incidental, part of the physician’s professional service Commonly rendered without charge or included in the physician’s bill Of a type that is commonly furnished in physician’s offices or clinics The physician must perform the initial service to establish the physician/patient relationship; includes the history and physical examination portion of the service and the treatment plan Note: Nursing services in PBDs and physician offices are always “Incident to” a physician Note: Hospital and skilled nursing facility services (SNF) cannot be billed as "incident to" at any time

Charge Description Master (CDM)

The CDM is the “Aorta” of the PBD Revenue Cycle
Update the CDM when new services, procedures, and/or products are added Update the CDM when prices of products change Update the CDM when labor costs change Create some test claims to verify the CDM is functioning as planned Educate staff how the CDM is programmed

Billing for Wound Care Supplies

Routine Supplies Routine supplies associated with a service or procedure should not be separately billed to the payer or the patient Not patient-specific supplies “Floor stock” e.g. cotton swabs, wipes The cost for routine supplies should be rolled into the charge for visits and procedures

Non-Routine Supplies Non-routine supplies are:
Patient-specific non reusable supplies e.g. surgical dressings Specifically ordered and documented in the medical record Non-routine supplies should be separately charged with the most appropriate revenue code in the “covered” column of the claim Revenue codes 270 and 271 are appropriate for non-sterile supplies Revenue code 272 is appropriate for sterile supplies Only report HCPCS codes for non-routine supplies with the OPPS status indicator of “H” or “N”; NOTE: All surgical dressing HCPCS codes have “H” status indicator. Payment is packaged into the visit or procedure Medicare allowable payment rate (not separately paid), but the charge influences future OPPS allowable payment rates

Medicare Beneficiary Identifier (MBI)

The MBI . . . Is no longer based upon the Medicare beneficiary’s social security number Cards were released in phases by geographic location Must be used by all providers on January 1, 2020

Insurance Benefit Verification
Top 10 Payers

Verify If Consolidated Billing (CB) Pertains to the Patient

Contract with HHA and SNF for Payment - if You Perform Services on the CB Lists

Hot SNF CB News Effective October 1, 2019 the following procedures will be added to the SNF CB list: paste/unna boot 29581 lower extremity application of strapping – any age 29584 upper extremity application of strapping – any age

Per Encounter Claim Submission

Revenue Codes That Should Be Billed Monthly
DME Rental Respiratory Therapy 0410, 0412, 0419 Physical Therapy Occupational Therapy Speech-Language Pathology Skilled Nursing Kidney Dialysis Treatments Cardiac Rehabilitation Services 0482, 0943 Pulmonary Rehabilitation Services 0948 Revenue Codes That Should Be Billed Monthly

Physicians Beware!

Do Not Request Payment for Work You Did Not Perform in a PBD
Application of total contact cast 29580 Application of Unna boot 29581 Application of multi-layer compression bandage 97605 Application of NPWT durable medical equipment 97607 Application of NPWT disposable equipment 98610 Low frequency, non-contact, non-thermal ultrasound 99183 Hyperbaric oxygen therapy attendance and supervision

Do Not Select Codes by the Payment Rates that You Prefer to Receive
If a procedure code in column 2 of the NCCI Edits has a higher payment rate than the procedure code in column 1, report the procedure code in column 1 Example: ($24.51) in column 1 should be reported instead of ($105.95) in column 2 If a code exists, you should use it Example: Do not select an E&M code when a code, such as 97597, exists

Verify Patients in Global Surgical Periods
See Tab 3

Global Day Assignment Only Applies to Physicians - Does Not Apply to PBDs!
000 or 010 Minor surgical procedure (includes E/M on day of procedure) 90 days Major surgical procedure (Medicare pays for an E/M service on the day of or on the day before a procedure, if modifier -57 is appended to the E/M code) XXX Global concept does not apply YYY Global period determined by the MAC ZZZ Procedures are related to other procedures and have the same global period

Services Included in Global Surgery Period
Pre-op visits…this means E/M is included! BEWARE of modifier -25! Surgical procedure Post-op visits Post-op pain management Treatment for complications that do not require a return trip to the O.R. Miscellaneous services (i.e., dressing changes, cast removal, etc.) NOTE: If a less extensive procedure fails and a more extensive procedure is required, the second procedure is separately payable

Services Not Included in Global Surgery Period
Decision for Surgery (modifier -57) – major 90-day procedures only Visits unrelated to the surgery’s diagnosis, unless related to a complication Treatment for the underlying condition or an added course of treatment that is not part of normal recovery from surgery Diagnostic procedures Treatment for complications that requires a return trip to the O.R. Distinct procedures or services unrelated to the surgery and which are not complications

Surgeon appends modifier -54 to surgical procedure code Modifier -54: Surgical Care Only Postoperative Services Provided by Another Physician/QHP Physician/QHP appends modifier -55 to same surgical procedure code; includes 1) date of surgery as “date of service”, or 2) date care assumed - if other than date of surgery or discharge Modifier -55: Postoperative Management Postoperative Services Provided by Other Physician/QHP Transfer of Care During Global Surgery Period

Questions

Coding

Justify Medical Necessity with Specific Primary, Secondary and Comorbidity Diagnosis Codes

Diagnosis Codes Affect Payment
Determine Determine if procedure/product is medically necessary and meets coverage requirements Determine accumulative Hierarchical Condition Categories (HCC) Risk Adjustment Factor (RAF) score of patients attributed to specific physician Determine Physician/QHP HCC RAF Score

HCC to RAF Process Diagnosis codes are sorted into diagnosis groups
Diagnosis groups are sorted into condition categories Related conditions are assigned to one category and only the most serious is counted A higher ranked condition causes lower ranked conditions in same category to be ignored (with a few exceptions) Unrelated conditions in different categories are both counted; the score is additive Condition categories are given a RAF score, which is used by numerous payment programs

RAF score of 1 = patient who uses an average amount of resources
HCC RAF Score RAF score of 1 = patient who uses an average amount of resources RAF score less than 1 = patient who will use fewer than the average amount of resources RAF score greater than 1 = patient with greater than average resource use

Clinic Visits and Procedures During Same Encounter

Do Not Routinely Report an E&M Code and a Procedure During the Same Encounter
Most wound management procedures have 0-Day or 10-Day global period E&M services are built into procedure codes with 0-day and 10-day global period Only use modifier -25 for a significant, separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure. The E&M service and minor surgical procedure do not require different diagnosis codes If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply. The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure

PBD Coding and Physician/QHP Coding Do Not Always Match

In a hospital outpatient PBD, when a physician assesses an established patient’s chronic wound and writes orders for the PBD staff to apply a total contact cast, the physician reports the appropriate E&M code and the PBD reports the code for the application of the total contact cast. Example

Debridement Code Selection

Select Debridement Code Based on Depth of Tissue Removed From Surface of the Wound
Single Wound: Report based on deepest level of tissue debrided Multiple Wounds: Total surface area of wounds debrided at same depth Do not combine surface area of wounds debrided at different depths

Then Select Code by the Amount of Tissue Debrided
Report (in sq. cm) the Amount of the Ulcer Surface Debrided Do Not Select the Code Based on the Size of the Ulcer, Unless the Entire Ulcer Was Debrided

Active Wound Management Codes
Should Be Used by All Professionals Certified to Debride Wounds

97597 Debridement of open wound, first 20 sq. cm, per session
Removal of: Fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm Method of Debridement: High pressure waterjet with or without suction Sharp selective debridement with scissors, scalpel, and forceps 97597 Debridement of open wound, first 20 sq. cm, per session

97598 Add-on code to 97597, for each additional 20 sq. cm debrided
Never use alone: it must be used WITH 97957 Do not use modifier 59 on with 97597, because is an add-on code

Examples One ulcer: 4 cm x 4 cm (16 sq. cm) of dermis removed
16 sq. cm total unit Two ulcers: 1st ulcer: 2 cm x 2 cm (4 sq. cm) 2nd ulcer: 4 cm x 4 cm (16 sq. cm) of dermis removed 20 sq. cm total unit Three ulcers: 1st ulcer: 2 cm x 2 cm (4 sq. cm) 2nd ulcer: 3 cm x 2 cm (6 sq. cm) 3rd Ulcer: 2 cm x 2 cm (4 sq. cm) of dermis removed 14 sq. cm total unit Examples

One ulcer: 5 cm X 5 cm (25 sq. cm) of dermis removed 25 sq
One ulcer: 5 cm X 5 cm (25 sq. cm) of dermis removed 25 sq. cm total unit (for first 20 sq. cm) unit for additional 5 sq.cm) Two ulcers: 1st ulcer 4 cm X 4 cm (16 sq. cm) 2nd ulcer 4 cm x 3 cm (12 cm) of dermis removed 28 sq. cm total unit (for first 20 sq. cm) unit (for additional 8 sq. cm) Examples

Medicare payment is attached to 97602 for PBDs
No Relative Value Unit (RVU) assignment for physicians and other QHPs: no Medicare payment attached to 97602 Medicare payment is attached to for PBDs 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion) including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

Surgical Debridement Codes
Not “excision”

11042 and 11045 NOTE: Includes epidermis and dermis, if performed
11042: Debridement of subcutaneous tissue, first 20 sq. cm or less 11045: Add-on code: each additional 20 sq. cm or part thereof NOTE: Includes epidermis and dermis, if performed

11043 and 11046 11043 Debridement of muscle/fascia, first 20 sq. cm or less 11046 Add-on code: Debridement of muscle/fascia, each additional 20 sq. cm or part thereof NOTE: Includes epidermis, dermis, and subcutaneous tissue, if performed NOTE: Verify if payer requires a pathology report?

11044 and 11047 11044: Debridement of bone, first 20 sq. cm or less
11047: Add-on code: Debridement of bone, each additional 20 sq. cm or part thereof NOTE: Includes epidermis, dermis, subcutaneous tissue, and muscle/fascia if performed NOTE: Verify if payer requires a pathology report?

4 cm x 3 cm (12 sq. cm) of subcutaneous tissue is debrided from an ulcer that is 6 cm x 6 cm (36 sq.cm) with exposed bone 1 unit (because debrided portion is 12 sq. cm of subcutaneous tissue) Example

If 2 Ulcers Are Debrided, Should 2 Debridement Codes be Billed?
If the same type of tissue was removed from both ulcers, add the number of sq. cm debrided and report 1 debridement code If different types of tissue were removed from both ulcers, report 2 different debridement codes

Example 97597 + modifier 59 1 unit (for 4 sq. cm of dermis debrided)
2 cm x 2 cm (4 sq. cm) of dermis debrided from ulcer on foot 6 cm x 6 cm (36 sq. cm) of muscle debrided from ulcer on leg modifier 59 1 unit (for 4 sq. cm of dermis debrided) 11043 1 unit (for first 20 sq. cm of muscle debrided) 11046 1 unit (for additional 16 sq. cm of muscle debrided) Example

Note the Work Included in all the Debridement Codes
Wound assessment Dressing application / change Education of patient and / or caregiver Topicals applied

CTP is correct term that replaces old term: “skin substitute”
Code Selection for Application of Cellular and/or Tissue-Based Products for Skin Wounds (CTPs) CTP is correct term that replaces old term: “skin substitute”

Appropriate Use of CTP Application Codes
The CTP is anchored using the physician’s/QHP’s choice of fixation The measurements for the application of CTP codes refer to the size of the recipient area – not to the size of the product purchased Removal of current CTP and/or simple cleansing of the wound, when performed, is included in the application of the CTP code DO NOT USE THE CTP APPLICATION CODES FOR APPLICATION OF NON- GRAFT PRODUCTS (E.G. GEL, POWDER, OINTMENT, FOAM, LIQUID) OR INJECTED PRODUCTS

Correctly Select CTP Application Codes
Size of Wound Surface Area 25 sq. cm increments up to 100 sq. cm First 100 sq. cm and additional 100 sq. cm increments Anatomic Location of Wound Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, digits Trunk, buttocks, arms (includes wrists), legs (includes ankles)

Application of CTPs for Wound Surface Area Smaller Than 100 Square Centimeters
CPT® Code Description 15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15272 —each additional 25 sq cm wound surface area, or part thereof 15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +15276 —each additional 25 sq cm wound surface, or part thereof

Application of CTPs for Wound Surface Area Greater Than or Equal to 100 Square Centimeters
CPT® Code Description 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children +15274 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children +15278 each additional 100 sq cm wound surface, or part thereof, or each additional 1% of body area of infants and children, or part thereof

Application of Low-Cost CTPs for Wound Surface Area Smaller Than 100 Square Centimeters
Code Description C5271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +C5272 —each additional 25 sq cm wound surface area, or part thereof C5275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area +C5276 —each additional 25 sq cm wound surface, or part thereof

Application of Low-Cost CTPs for Wound Surface Area Greater Than or Equal to 100 Square Centimeters
Code Description C5273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children +C5274 each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof C5277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children +C5278 each additional 100 sq cm wound surface, or part thereof, or each additional 1% of body area of infants and children, or part thereof

Report “Q” Code Assigned to the CTP in Square Centimeters
Report the number of sq. cm opened Do Not Report a Unit of “1”

Add Appropriate Modifiers to “Q” Code
JC Skin substitute used as a graft JW Skin substitute not applied to wound, wastage Report wastage on 2 claim lines Q41xxJC units used Q41xxJW units waste Add Appropriate Modifiers to “Q” Code

A PBD purchased 21 sq. cm of a covered CTP; the entire piece was applied to a 15 sq. cm diabetic foot ulcer on the left heel unit (because wound was less than 20 sq. cm) Q4xxxJC 21 units (because 21 units were purchased and applied) Example

Example A PBD purchased 100 sq cm of a covered CTP:
21 sq. cm was applied to a 15 sq. cm venous stasis ulcer on the left leg, and 70 sq. cm of the same CTP was applied to a 65 sq. cm venous stasis ulcer on the right leg The total wound size was 80 sq. cm 1 unit (for first 25 sq. cm of the ulcer) 3 units (for the additional 55 sq. cm of the ulcer) Q4XXXJC 100 units (for the 100 sq. cm purchased) Example

A physician office purchased 140 sq
A physician office purchased 140 sq. cm of a covered CTP and applied 110 sq. cm to a 100 sq. cm venous stasis ulcer on the right leg 1 unit (because the ulcer was exactly 100 sq. cm) Q4XXXJC 110 units (for the 110 sq. cm applied) Q4XXXJW 30 units (for the 30 sq. cm wasted) Example

Use Site Preparation Codes 15002-15005 With Caution
Novitas Solutions’ LCD, Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041), states: “Repeat use of surgical preparation services in conjunction with skin substitute application codes will be considered not reasonable and necessary. It is expected that each wound will require the use of an appropriate wound preparation code at least once at initiation of care prior to placement of the skin substitute graft.” Use Site Preparation Codes With Caution

Pass-Through Status of CTPs

APC National Average Allowable Rate
When a CTP has Outpatient Prospective Payment System (OPPS) Pass-Through Status, the PBD Receives: APC Group APC National Average Allowable Rate Co-Payment Device Offset Amount 5054 $1,548.96 $309.80 $737.11 5055 $2,766.13 $553.23 $185.54 Packaged payment for the appropriate APC group Payment for the CTP is equal to the difference between the average sales price (ASP) of the particular size CTP purchased and the device offset amount for the appropriate APC group

“No Cost” PBD Billing for Packaged CTPs
Report Q code for CTP acquired at “no cost” Report total number of units acquired at “no cost” Report a charge less than $1.01 in the 1) non-covered charge field and 2) total charge field of claim The Medicare allowable payment will be reduced by the “device offset” amount affiliated with the appropriate APC assignment Report appropriate application code ( /C5271- C5278) with the –FB modifier (item provided without cost to provider, supplier, or practitioner, or credit received for replacement device [example, free sample]

CTP Charges Affect Future Payments
Positively or Negatively CTP Charges Affect Future Payments

Does it charge for number of sq cm of specific CTP purchased for each application?
Does the CDM multiply the number of sq. cm purchased by the PBD’s charge per sq. cm? Do claims include the correct number of sq. cm of the CTP purchased and the correct marked-up charge? Steps to Verify that Your Charging System is Set Up Correctly for the Application of CTPs

Questions

Coverage

National and Local Coverage Determinations (NCDs & LCDs)

Components of an LCD Novitas Solutions, Inc.

Coverage guidance: indications, limitations, medical necessity
Documentation requirements Utilization guidelines Place of service restrictions Attached and/or separate Articles may provide coding guidance NOTE: Physicians/QHPs are responsible to comply with all LCD guidelines Review Medicare LCDs and Articles

Develop an LCD/Article Review Process
Provide Provide oral and written comments about draft LCDs Assign Assign someone to review all revised, draft, new, and retired LCDs and Articles: educate entire medical and revenue cycle team Review Review all pertinent active LCDs and Articles: Develop an LCD/Article Review Process

Advance Beneficiary Notice of Noncoverage
ABN

Use a Medicare ABN When the Service is:
Experimental and investigational or considered “research only” Not indicated for diagnosis and/or treatment in this case Not considered safe and effective More than the number of services Medicare allows in a specific period for the corresponding diagnosis Note: Private insurers may require similar forms (Waiver of Liability) Use a Medicare ABN When the Service is:

An ABN Should . . . Be given to a patient when a service that is normally covered by Medicare may not be covered for that patient Include a description of the service, procedure, or products you expect Medicare may not cover Include the reason Medicare may not cover Include the estimated cost to the beneficiary

Questions

Payment See Tab 4

Outpatient Prospective Payment System (OPPS)
APC Groups Status Indicators National Average Allowable Rates and Co-Payments

Factors that Determine If Medicare Will Reimburse for 2 Procedures Performed During the Same Encounter Does an NCD, LCD, and/or Article allow for billing of both procedures? For PBDs, what does the OPPS allow? For Physicians/QHPs, what does the MPFS allow? Does a National Correct Coding Initiative (NCCI) edit exist for the 2 procedures?

National Correct Coding Initiative (NCCI) Edit

See Tab 5

Use Distinct Procedure Modifiers When Appropriate
XE Separate encounter XS Separate structure XP Separate practitioner XU Unusual nonoverlapping service Use Distinct Procedure Modifiers When Appropriate

Rules for Reporting Distinct Procedure Modifiers See Tab 6
Through June 30, 2019 Medicare required that modifiers -59, -XE, -XS, -XP or -XU be appended to the column 2 code of a NCCI Procedure-to-Procedure (PTP) edit to bypass the edit and allow separate payment Effective July 1, 2019 Medicare allows modifiers -59, XE, XS, -XP or –XU to be appended to either column 1 OR column 2 codes to bypass the NCCI edit and allow separate payment

NCCI Edit: E/M or Clinic Visit w/a Procedure on the Same Day
Report E/M CPT code with modifier -25 when a significant and separately identifiable E/M service (unrelated to the decision to perform a minor surgical procedure) by the same physician/QHP on the same day the procedure is performed NCCI Edit Manual: “The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E/M service on the same date of service as a minor surgical procedure.” Per CPT® Manual – “New patient” is one who has not received any professional services from the physician, or another physician of the exact same specialty and subspecialty within the same group practice, within the past three years. NOTE: For PBD: Not seen in health system for the last 3 years

Medicare Physician Fee Schedule (MPFS)
Relative Value Units (RVU) – Facility and Non-Facility Global Surgery Days and Associated % of Pre-op, Intra-op, and Post-op National Average Allowable Rates – Facility and Non-Facility Multiple Procedure Reduction (MPR) Conversion Factor (CF) (Total RVU x CF = Medicare National Average)

Questions

Audits

To Prevent and/or Prepare for Audits, Conduct Self-Audits of Your Coding, Documentation and Paid/Denied Claims

Perform Self-Audits on Pertinent Topics
Did documentation support medical necessity for codes on claims, such as debridement, application of cellular and/or tissue-based products for skin wounds (CTPs), hyperbaric oxygen therapy, surgical dressings ordered for home use? Did claims reflect correct codes, modifiers, units, and charges? Did physician sign all orders and documentation? Perform Self-Audits on Pertinent Topics

Targeted Probe and Educate (TPE) Audits

MACs will pull claims for items/services that pose the greatest financial risk to the Medicare Trust Fund and/or those that have a high national error rate Rather than a full code review for all providers, TPE audits will target specific providers and suppliers, with outlier tendencies, who have claims error and billing rates “significantly” outside the norm TPE Audit Facts

See Tab 7

TPE Preparation Tips Verify Provide Take Advantage
Verify your address in the contacts section of the Provider Enrollment, Chain and Ownership System (PECOS) Do not miss receiving the initial TPE letter from your MAC Provide Provide requested documentation and meet required timelines (file in 30 days rather than 45 days) No response equals non-compliance and an increased error rate Take Advantage Take advantage of the complimentary education TPE Preparation Tips

Questions

Thank you for inviting me to share reimbursement education with you . . .
Kathleen Schaum

Coding/Billing: The Business Side of Wound Care

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