Avoiding Claim Denials For AMCC Tests

Avoiding Claim Denials For AMCC Tests

When billing with medical modifier codes for automated multi-channel chemistry it is important to bill correctly to prevent denial.

When a patient has end-stage renal disease it is important to use the 50/50 medical billing rule. This rule requires automatic multi-channel chemistry tests to be correctly identified on claims. Recently, the Centers for Medicare & Medicaid services has decided to deny laboratory claims that do not comply with this rule. The correct medical billing modifier for an automatic multi-channel chemistry test is required in order to prevent this denial from occurring. This is required when ever a medical end-stage renal disease facility or a doctor performs the billing and gets a monthly capitation payment.

There are three categories in which the Centers for Medicare & Medicaid Services deem appropriate medical billing modifiers for AMCC tests. The first category is Modifier CD. This means the automatic multi-channel chemistry test is not separately billable, but is part of the composite rate. The second category for medical billing is Modifier CE. This means it is separately billable, and is a composite rate test, but goes beyond a frequency that is normal. The final medical billing category is modifier CF. This is also separately billable, but is not a part of the composite rate.

If these automatic multi-channel chemistry tests are not billed with the correct modifiers, payers will deny the claim. If experience billers perform the medical billing, Automatic multi-channel chemistry test denials will not be an issue. By outsourcing your billing to a medical billing firm you will ensure correct procedure and reimbursement on the very first submission. They are extremely professional and know the ins and outs of medical billing.

Categorizing your automatic multi-channel chemistry tests right away will save you many headaches in the future.

View all Articles by: Melissa Clark, CCS-P