Becker's Healthcare August 24, 2022
The HHS and Labor Department Aug. 19 issued the final rules for the No Surprises Act.
Here are the three changes that ASCs need to know:
1. The final rule defined the term “downcode” to mean the alteration of a service code to another service code or the removal, addition or alteration of a modifier with a lower qualifying payment amount than the service code billed.
When a qualifying payment amount is based on a downcoded service code or modifier, the issuer or plan must provide the following with its initial payment:
- A statement that the service code or modifier billed was downcoded
- An explanation of why the claim was downcoded, including which codes or modifiers were...
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