$4.6 million in Claims Paid Incorrectly by CMS when Using KX ModifierJanuary 16th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
$4.6 Million was paid by CMS for claims that did not comply with Medicare requirements. The claims were paid in 2017 and reported by the Office of Inspector General (OIG) stating, "A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements".
The KX modifier is used to report correct documentation is on file, this modifier should be used in the context of the claim, indicating that the provider or supplier has ensured coverage criteria for the product or service has been met and documentation exists to support the medical necessity.
KX - SPECIFIC REQUIRED DOCUMENTATION ON FILE
Be sure you are using this modifier correctly, clarify the usage of the following documents.
- Pharmacy Billing of Immunosuppressive Drugs MLN Matters® Article
- Clarification of the Billing of Immunosuppressive Drugs MLN Matters Article
- Change Request 10235
- OIG Report on the proper use of the KX modifier for Part B immunosuppressive drug claims
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)Important Podcast on Dental to Medical Billing
September 21st, 2020 - Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
September 15th, 2020 - Wyn Staheli, Director of Research
September 1st, 2020 - Wyn Staheli, Director of Research
August 28th, 2020 - Jared Staheli
August 27th, 2020 - Innoventrum
August 27th, 2020 - Wyn Staheli, Director of Research
August 26th, 2020 - Christine Taxin - Links 2 Success