Medicare Compliance – Built in Rules
Medicare Compliance
Custom Hard-Stop Compliance feature prevents the #1 reason for denied Medicare claims – incomplete/errors in patient treatment records. We sync your patient’s records with appointment schedules to ensure eligibility is never interrupted by denied claims!
Complying with Medicare Guidelines can seem like a daunting process. After all, to get paid you need the following:
- Current Plan of Care signed by a physician or nurse practitioner in a timely manner
- Progress reports every 10 visits or 30 days
- Proper code for electrical stimulation
- Correct NCCI edits
- Correct modifiers for your area of practice
- Correct modifiers for certain CPT codes used together
- Correct CQ/CO modifiers
- Follow 8-minute rule
- Track Medicare reimbursement/apply KX modifier at right time
SYSTEMS4PT’s Medicare Compliance assures you every day your patient records are up to date, and treatment notes are complete with features including, but not limited to:
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Tracking of Medicare KX modifier Threshold
- Hard-Stop on 10-day visit/30-day Progress Note requirement.
- Hard-Stop on POC/Prescription Expiration
- Hard-Stop to correct G0283 coding requirement.
- NCCI coding alert with appropriate modifier application if therapist approved.
- Effortless MIPS participation through a QCDR
- 150 – 500 words of required MIPS-specific defensive documentation recommended, touch free
- 80 – 200+ words of compliant, defensive, evaluation code rationale documentation recommended, touch free
