APMA's 25th Annual Joint National Contractor Advisory Committee-Private Insurance Advisory Committee (CAC-PIAC) Meeting convened virtually on Friday, November 14, drawing representatives from across the country for a full day of education, collaboration, and problem-solving on the evolving payer landscape.
Highlights included:
Please follow this link for a full meeting recap and for links to reference for the WISeR prior authorization process.
Visit here for additional meeting resources, updates, and follow-up materials. To learn more about CAC and PIAC representatives and identify your own state representative(s), visit this page today.
APMA is deeply concerned by recent Office of Inspector General (OIG) reports addressing podiatrists’ claims for evaluation and management (E/M) services billed with modifier 25 and podiatrists' routine foot care claims. The reports, titled “Podiatrists’ Claims for Evaluation and Management Services Did Not Comply with Medicare Requirements” and "Podiatrists' Claims for Routine Foot Care Services Did Not Comply with Medicare Requirements," make sweeping claims regarding podiatrists’ compliance. These claims fail to recognize the value of care delivered by our profession and are not reflective of care delivery and claims billing today.
While APMA fully supports efforts to ensure proper Medicare billing, the framing of the reports is troubling and risks creating a misleading narrative about podiatric medical practice. Podiatric physicians regularly perform procedures while also performing significant and separately identifiable evaluation and management services at the same encounter, making appropriate use of modifier 25 both clinically justified and common. The OIG’s finding that 44 out of 100 sampled E/M claims did not fully comply with Medicare requirements must be interpreted with great caution, particularly in light of the time that has elapsed since the services in the report were furnished.
APMA calls on CMS and the MACs to ensure that any additional oversight or educational efforts recommended by the OIG are transparent, supported by clear guidelines. They should also recognize and accommodate the clinical realities of patient care. APMA encourages its members to make use of the association’s 25 modifier and routine foot care resources to help ensure compliance with Medicare requirements.
1. Visit the APMA’s 25 modifier toolkit at www.apma.org/25modifier
2 . Take advantage of the E/M resources page at www.apma.org/EM
3. Find Routine Foot Care and -59 Modifier Claims Tool Kit at www.apma.org/59toolkit, and check out a helpful infographic on routine foot care.