Florida Dermatology Billing: The Vendor Evaluation Questions That Reveal CO-50 Defense and Mohs Billing Capability

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Choosing a medical billing or RCM vendor for a Florida dermatology practice requires more than comparing collection percentages and monthly fees. Dermatology billing has specialty-specific risks, particularly when a practice performs Mohs micrographic surgery, pathology-related services, biopsies, and other procedures where documentation, medical necessity, coding, and payer policies directly affect reimbursement. One important area to examine is the vendor's ability to prevent and defend CO-50 denials . CARC 50 indicates that a service was considered non-covered because the payer did not determine it to be medically necessary. CMS guidance also shows that CO-50 can be used following medical review when a payer determines that coverage requirements have not been met. For a Florida dermatology practice, the vendor evaluation process should therefore go beyond asking, "How much do you collect?" The better question is: "How do you protect our revenue when a payer challe...
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Correct Use of Modifier 50 in ASC Billing

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Modifiers are two-digit symbols added to CPT procedure codes to signify the procedure has been altered in some way. Modifiers are accepted by Medicare and most other payers, however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way. Medicare defines the ASC facility’s Global Period to be 24 hours from the time the first procedure begins – it is NOT 10 or 90 days like the physician’s Global Period might be. However, some payers other than Medicare might consider the Global Period to be 48 – 72 hours for ASC facilities. Some Modifiers are for use by physician practices only, some for use on facility claims only, and some are for use by both provider types. In this Blog, we have discussed the correct use of modifier 50 in ASC billing.

Not using Modifiers according to each payer’s specifications can cause unnecessary denials or cause claims to not pay properly. Certain Modifiers are for use because the patient had to return to the OR for another procedure the same day or close to the time another procedure was performed in your facility – which is referred to as the “Global Period” or “Postoperative Period.”

Modifier 50 in ASC Billing: Bilateral Procedures

For Bilateral procedures, use the -50 or -RT/-LT modifiers when an identical procedure is performed on both the Right and Left sides of the body. The policies payors have for the use of modifiers for reporting bilateral procedures can vary. Check with each payor for their preferred method of billing bilateral procedures.

Do not mix methods or modifier types. Never use the -RT/-LT Modifiers on the same code listed on the claim as one line item. Billing with one line item can only be done using the -50 Modifier (which is not accepted by Medicare). Do not mix the -50 Modifier with –RT or –LT Modifiers. Do not use Bilateral Modifiers on those CPT codes with verbiage describing procedures as “Bilateral” or “Unilateral or Bilateral”.

To know more about the Correct Usage of Modifier 50 in ASC Billing and Modifiers LT and RT for Bilateral Procedures, click here: https://bit.ly/40pqtKy Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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