Our “Increasing Your Bottom Line” campaign which is geared specifically to help your organization submit your Medicare Part B claims accurately the first time, now focuses on Modifiers 26 and TC. Remember, significant savings are possible for your organization by reducing rework. As it relates to Medicare billing, the best way to reduce rework and the accompanying costs is to submit your Medicare claims accurately upon initial submission. Sounds simple, but Novitas receives approximately 1.7 million CER (Clerical Error Reopenings) every year from Medicare Part B providers to correct claims that were submitted incorrectly the first time.
CERs are submitted to correct minor errors or omissions of claim specific information. That is a staggering amount of rework costing time and money for both you and the Medicare Program—costs that could be avoided by everyone if the claims were submitted correctly the first time. In addition to the painful cost of rework, it also means that you need to wait for Medicare to process your corrected claim for payment. The next topic in our series will focus on the correct use of Modifiers 26 and TC. Click on the links for more detailed information regarding these modifiers.
Modifier 26 is defined as “Professional Component” and should be appended to a procedure code when the provider rendered only the professional component of the service.
Modifier TC is defined as “Technical Component” and should be appended to a procedure code when the provider rendered only the technical component of the service.
Modifier 26 - One of the most frequent reopening requests we receive is based on the failure to correctly indicate professional component for services in a SNF (Skilled Nursing Facility). Each month we receive a significant number of reopening requests to add Modifier 26 to services performed in a SNF because the physician simply failed to include the modifier. Without the Modifier 26, the service is denied so the provider then contacts Novitas to request that Modifier 26 be appended to the procedure code in order to receive payment for the professional component of the service.
Modifier TC – ASCs (Ambulatory Surgical Centers) frequently contact Novitas to add Modifier TC to procedure codes that have both a technical and professional component. Without the TC modifier, the service will be denied. Because ASCs are not paid for the professional component of services that have both a technical and professional components, the Modifier TC must be appended to indicate the technical component only.
Before using the 26 or TC modifiers, check to see that the procedure code can accept these modifiers. An indicator of "1" in the PC (Professional Component)/ TC (Technical Component) field on MFSDB (Medicare Physician Fee Schedule Database) signifies that Modifiers 26 and TC are valid for the procedure code.
Click
here to inquire against the Medicare Physician Fee Schedule Data Base
If the same provider is performing both the technical and professional component of a service, the global service
(i.e. the procedure code without the TC or 26 Modifier) should be reported
The TC or 26 Modifier should be reported in the first modifier position on the claim
As we continue our campaign, future articles will focus on the most frequent administrative errors submitted on Medicare Part B claims. We encourage you to watch for and read these articles and then share the articles in your organization as training tools to assist billing professionals in eliminating these errors. It’s a win-win situation for your organization and the Medicare Program when you no longer have to request a CER to correct a billing error allowing you to spend more time and attention on patients and other activities important to your organization.
In addition to the above information, Novitas has a wealth of resources and training courses available on our website to help your organization reduce administrative errors or omissions on your claims, and some of those resources are listed below. We encourage you to visit our website at www.novitas-solutions.com and explore the virtually endless supply of information, online tools, and self-help options. Your organization may also request a Provider Outreach and Education Specialist to provide specialized education to your organization by completing a Part B Request for Education Form, which is available on our website.
Coding Guidelines |
General Education Resources |
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For those times when a billing error does occur, despite your organization’s best attempt to avoid a mistake, please use the Novitasphere Portal to submit your CER electronically. It’s faster, easier, and more cost effective for you and for the Medicare Program. Novitasphere is a secured web-based Internet Portal enabling provider to initiate a CER as well as perform benefits & eligibility inquiries, perform claim inquiries, retrieve remittance advices, and perform claim submissions.
For instructions to initiate a CER via the Novitasphere portal, or for information to enroll for Novitasphere, please visit the Novitasphere Portal page on our website for everything you need to get started and work faster!
When it is necessary to submit a CER or an appeal, please visit the Appeals Center, which provides comprehensive information on the forms, process, timeframes, and requirements for the appeal of a claim determination.
Watch for the next article in the “Increasing Your Bottom Line” series to be published soon and start your organization’s initiative to stamp out rework to save time and money!
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