“We are having difficulty with a denial when combining CPT 28320 and CPT 20680. CPT 20680 is being rejected as unbundling. According to CCI edits, CPT 28320 is a Column 1 code and CPT 20680 is a Column 2 code and they are allowed. The surgeon removed hardware from a prior surgery performed by a different surgeon not associated with the practice then repaired a non-union and applied new fixation. Is the removal of prior hardware actually included in CPT code 28320? If not, what modifier should be used if it is the same incision/surgical site as the non-union repair?”
CMS announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers, which are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act, repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden health care providers faced while experiencing cash flow issues in the early stages of combating the Coronavirus Disease 2019 (COVID-19) public health emergency.
CGS's Medical Review staff will be conducting a complex post-pay service-specific medical review of HCPCS Codes L1902; L1906; L1971; L4396; L4397 (Ankle-Foot Orthosis). This review will be conducted because data analysis revealed that Jurisdiction B's allowed dollars for HCPCS Codes L1902; L1906; L1971; L4396; and L4397 were significantly above expected amounts. Additionally, the Orthotics policy group ranked #1 in total CERT errors.
When we discuss HIPAA most of the articles have been on security and breaches, but HIPAA goes well beyond privacy and Security. One aspect of the HIPAA rule is the “Right of Access”.
OCR (The Office for Civil Rights – the branch of HHS the enforces HIPAA) is enforcing this law even more strongly since the 21 Century Cures Act was published. OCR has begun to levy fines against organizations that are in violation of the “Right of Access” rule.