Since the majority of patients do not understand the need to separate codes into their components, it is important to understand component billing so we can explain it to the patient. Knowing when and how to use modifiers is important in resolving claims denials and results in a better payment history in the long run. Shavara has the accumulated ' experience capital ', the market know-how, the intricacies of coding, billing and connectivity that we have 'learned'.
To "catalyze" is to rapidly advance by applying powerful tools and industry expertise. Catalysis becomes the process to gain access to the power, apply it to solve gaps and vulnerabilities - then rapidly advance. Shavara possesses the tools to apply Catalysis via collaborative engagements.
Our infinite targets are the enterprise organizations: Hospitals, clearinghouse processors, Insurance companies payers , and large physician practices, peppered throughout the Healthcare system that all share equally the challenges, pitfalls, inefficiencies, ineffectiveness, and the deliberate speed-bumps placed there by bureaucrats to slow down the revenue cycle.
What are the costs of these speed-bumps to the Healthcare system? The costs are in the billions. Therefore, solving this eliminates and holds the potential to improve organizational effectiveness, reduce the cost of healthcare and improve healthcare outcomes.
So, who is Shavara? What is that old lamp on the corner of the desk? Skip to content Common questions. March 23, Joe Ford. Table of Contents. Most radiology services or procedures, although described by a single CPT code, comprise two distinct portions: a professional component and a technical component. The professional component is provided by the physician, and may include supervision, interpretation, and a written report. To claim only the professional portion of a service, CPT Appendix A "Modifiers" instructs you to append modifier 26, professional component, to the appropriate CPT code.
Modifier 26 is appropriate when the physician supervises and interprets a diagnostic test, even if he or she does not perform the test personally.
The technical component of a service includes the provision of all equipment, supplies, personnel, and costs related to the performance of the exam. To claim only the technical portion of a service, append modifier TC, technical component, to the appropriate CPT code. Fees for the technical component are reimbursed to the facility or practice responsible for these costs. Technical component charges are institutional charges and not billed separately by physicians.
However, portable x-ray suppliers only bill for technical component and should utilize modifier TC. The charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles. The use of the modifier is required for CPT codes — in those instances when the physician is only billing for the professional component of the laboratory test ie, medical direction, supervision or interpretation.
This method of reporting is appropriate when the technical and professional components are reported separately. There are a number of ways to report the professional services of the physician in the hospital clinical laboratory.
The physician may bill the patient or patients insurer or the hospital. Billing using the modifier is allowed for interpretation of specified tests. For non-Medicare patients, pathologists and hospitals frequently negotiate different billing arrangements for professional services.
In many communities, the standard practice is for the pathologist to direct bill patients for the professional component of clinical laboratory services. When the pathologist bills a professional component to a non-Medicare patient, no payment is made by the hospital to the pathologist for this service. In closing, when reporting the technical component of a procedure or service, it is important to familiarize yourself with the various reporting requirements of individual insurance companies in your area.
These reporting and reimbursement policies may vary from one insurance company to another. Use TC modifier only for the medical equipment, Facility or the technician. Using only TC modifier indicates only the technical portion of the procedure is used. Use 26 modifier for the physician or professional services only. Also, do use them for CPT codes like with description interpretation and report only. When both the professional and technical portion is provided by the physician, we are not supposed to use 26 or TC modifier along with CPT code.
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