Cardiology Question for the Week of December 24, 2018

Cardiology Compliance Question of the Week

Question:

What is the Medicare policy related to payment for a cardiac device that the manufacturer supplies at no cost or reduced cost?

Answer:

When an implanted cardiac device is replaced at reduced or no cost to the hospital or with partial or full credit for the removed device, the Centers for Medicare & Medicaid Services (CMS) reduce Medicare payment. Hospitals receiving cardiac devices at no cost or with credit must use proper modifiers and/or condition codes when submitting inpatient or outpatient claims, so Medicare only reimburses the reasonable cost of the device and no overpayments occur.

Details about this policy are covered in a fact sheet that can be found at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/cardiacdevicecredits-ICN909368.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.