New technology. Correctly identified, coded, and paid.
GRT identifies potential Medicare Add-On Payment opportunities by connecting qualifying technologies, charge detail, claim coding, and Medicare payment logic.
Find potential missed Medicare Add-On Payment reimbursement.
GRT reviews account-level and charge-level data, validates that the qualifying medication or device was ordered, charged, and administered or used, confirms the required claim coding, and compares payment with and without the qualifying code to determine the incremental reimbursement opportunity.
The technology may be present in the patient's care, but the payment depends on identifying it, coding it correctly, and validating how Medicare priced the claim.
Qualifying technologies change annually
The drugs, biologics, and devices eligible for New Technology Add-On Payments can change each fiscal year, along with the applicable payment rules and limits.
Expected reimbursement is difficult to calculate
NTAP reimbursement depends on claim-specific payment logic, so even comprehensive expected-payment methodologies may not accurately calculate the incremental amount.
Payment is difficult to verify
A claim may be paid without making it obvious whether the NTAP amount was included or whether the add-on payment itself was calculated correctly.
Required ICD-10-PCS coding may be missing
A qualifying technology may have been used, but the procedure code needed to trigger or support the additional payment may not be present on the final claim.
Clinical use may not flow cleanly to billing
The drug or device can appear in the medical record or charge detail while the information needed to support the NTAP payment does not make it onto the claim.
Charge detail must be connected to claim coding
Internal charge codes, NDCs, device descriptions, procedure codes, and claim coding often have to be connected to determine whether a qualifying technology was actually present and properly billed.