Photo of a man giving himself an insulin shot at home

New Modifiers: Hospital Outpatient Billing for Injectable Self-Administered Drugs

Do you and your team have a good process to readily identify and bill appropriately for self-administered drugs?

The Centers for Medicare & Medicaid Services (CMS) has had a longstanding policy excluding self-administered drugs (SADs) under the outpatient Part B benefit. Oral drugs, suppositories, and topical medications, for example, are easy enough to identify as self-administered, and medications normally administered by intramuscular injection are not usually considered self-administered. But what about drugs administered subcutaneously? Read more

Computer image of a person pointing at an overlay that reads Compliance

What’s on Your 2021 OIG Compliance Greatest Hits List?

Compliance plans are critical to making sure your organization is mitigating risk. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recommends that you audit a minimum of 10 professional encounters per year, per physician – but if you’re not going above and beyond that by performing focused audits, you’re putting your practice at risk by ignoring everything else (not to mention, you may be missing opportunities by under-coding). Read more