|| Medicare Liaison-Alfred Moffett, MD
Medicare Liaison Report
The Carrier Advisory Committee for Medicare met on October 13, 2012 in Orlando to discuss various items.
Discover “The SPOT” where access to Medicare data is only a click away…
November, 2012 marks the beginning of an exciting new era in claims data services provided by First coast Service Options. For the first time, the members of First coast’s provider community will have the opportunity to enjoy the benefits of online data access as a time and cost-efficient alternative to other customer service channels.
First coast is proud to introduce its brand-new, Internet provider portal: Secure Provider Online Tool (The SPOT). The SPOT is an innovative Web-based application that offers health care providers the convenience of real-time access to essential Medicare data in the safety of a secure, online environment.
Your Direct Connection to Medicare Data through the SPOT not only safeguards proprietary and protected health information (PHI) but also offers providers the advantage and versatility of faster access to Medicare data online:
-Claim Status – check the status of your Medicare claim by line item and view related payment and claims information.
-Benefits/Eligibility – verify a beneficiary’s eligibility status and view his/her benefits data regarding deductibles/caps, preventive services, plan coverage, inpatient/hospice, and Medicare secondary payer (MSP) coverage.
-Payment History – search your Medicare claims history for payment information by date, check number, of for the last three payments.
-Data Reports – analyze your billing patterns and improve your bottom line with detailed data compiled from comparative billing reports (CBR) and provider data summary (PDS) reports.
Assistant Surgery Modifiers
It appears that some providers are billing the services of surgical assistants under the performing provider number of the surgeon performing the surgical procedure as if “incident to” provisions applied to the services. These services are being billed with an 80 modifier, which indicates the assistant at surgery services were rendered by an assistant surgeon.
Assistant at surgery services rendered by a surgical technician, a first surgical assistant, scrub nurse, or any person bearing a title other than physician, PA, NP, CNS, or nurse midwife are not payable by Medicare Part B and is not billable to the patient. Billing the services of a non-covered assistant at surgery under the surgeon’s performing provider number is an inappropriate application of the “incident to” guidelines, and any services billed in this manner represents an overpayment to the provider and must be refunded to the Medicare program.