The Wilshire Group Blog

As of January 1, 2015, CMS made changes to how the modifier -59 should be used. Current guidelines result in -59 being used incorrectly on a frequent basis and as a result of this misuse, there is a high risk of overpayment and audit from OIG, RAC, or [...]

CMS (Center for Medicare & Medicaid Services) has been working to decrease a number of conditions they feel should not happen while patients are in the hospital = HAC (Hospital Acquired Condition). The ACA (Affordable Care Act) created the HAC Reduction [...]