Retro application of the KU modifier on complex rehab chair (K0848-K0864). The KU modifier is a pricing modifier (created in July but effective for DOS after January 1, 2016). KU should be added to wheelchair accessory HCPCS used with complex rehab bases (K0848-K0864). The KU secures a higher reimbursement rate guaranteed by PAMPA (passed into law on December 28, 2015 and provides an exemption from competitive bid rate decreases). Due to system limitations, the MACs could not properly pay these claims between January 1, 2016 and July 5, 2016. Affected claims need to be reprocessed to pay at the higher fee schedule. The MACs are instructing suppliers to request a reopening of these claims by sending in a spreadsheet of affected claims to the respective reopening department. We recommend querying your billing software for complex chair bases (K0848-K0864) delivered between January 1, 2016-July 5, 2016 to identify the affected population of underpaid accessories.
We have really enjoyed interacting with all of you through our MiraVista Myth Busting series regarding filing non-assigned claims and leveraging upgrades and cash sales.
To refresh your memory, we covered the following top myths:
In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases. This is the fourth article in a four part mini-series to break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales. Below you will find the fourth myth in the series:
Myth #4: An Advance Beneficiary Notice (ABN) must always be executed before a claim can be filed non-assigned.