Understanding Assistant-At-Surgery and Co-surgeon Claims

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The Office of Inspector General (OIG) recently completed an audit on their work plan of co-surgeon claim payments to determine if the payments complied with federal requirements. Per the OIG, their findings were as follows: “From our 100 statistically sampled services, we found that 69 did not comply with Federal requirements. Specifically, these statistically sampled services included 49 that were incorrectly billed without the co-surgery modifier, 14 that were incorrectly billed without an assistant-at-surgery modifier,…

Group vs. Concurrent Therapy Part 2: Are You Documenting Accurately?

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In Part 2 of this two-part blog series “Group vs. Concurrent Therapy: Are You Documenting Accurately?” we will discuss actual documentation of examples that may not support group and concurrent therapy as skilled and reasonable. In Part 1, we reviewed the definitions of group and concurrent therapy. Both definitions can be found in the Resident Assessment Instrument (RAI) Manual, Pages O-23-O-25. To refresh your memory, the Centers for Medicare & Medicaid Services (CMS) currently defines…

Group vs. Concurrent Therapy Part 1: Are You Documenting Accurately?

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Since October 1, 2019, for Medicare A recipients, the Resource Utilization Groups (RUGS) IV is out and the Patient Driven Payment Model (PDPM) is in. The first two years of the transition were complicated by COVID and the PHE. But since May 2023 when the PHE ended, things have been getting back to normal. It is important to remember that although the reimbursement model has changed, the regulations outlined in the Centers for Medicare &…