Medicare Compliance – Built in Rules
Medicare Compliance
Custom Hard-Stop Compliance feature prevents the #1 reason for denied Medicare claims – incomplete/errors in patient treatment records. We sync your patient’s records with appointment schedules to ensure eligibility is never interrupted by denied claims!
Complying with Medicare Guidelines can seem like a daunting process. After all, to get paid you need the following:
- Current Plan of Care signed by a physician or nurse practitioner in a timely manner
- Progress reports every 10 visits or 30 days
- Proper code for electrical stimulation
- Correct NCCI edits
- Correct modifiers for your area of practice
- Correct modifiers for certain CPT codes used together
- Correct CQ/CO modifiers
- Follow 8-minute rule
- Track Medicare reimbursement/apply KX modifier at right time
![Compliance concept diagram with related keywords and elements](https://systems4pt.com/wp-content/uploads/2020/02/S4Compliance.jpg)
SYSTEMS4PT’s Medicare Compliance assures you every day your patient records are up to date, and treatment notes are complete with features including, but not limited to:
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Tracking of Medicare KX modifier Threshold
- Hard-Stop on 10-day visit/30-day Progress Note requirement.
- Hard-Stop on POC/Prescription Expiration
- Hard-Stop to correct G0283 coding requirement.
- NCCI coding alert with appropriate modifier application if therapist approved.
- Effortless MIPS participation through a QCDR
- 150 – 500 words of required MIPS-specific defensive documentation recommended, touch free
- 80 – 200+ words of compliant, defensive, evaluation code rationale documentation recommended, touch free
![ComplianceMIPS Medicare Compliance](https://systems4pt.com/wp-content/uploads/2021/03/ComplianceMIPS.jpg)