Online Training Course

Using Modifiers to Improve Claim Accuracy

Don't lose revenue because of modifier misuse, non-use or to bypass CCI edits! This course will explain modifiers and when it is appropriate to use a modifier to obtain proper payment.


 Hear a sample of our course.




180 min



Modifer usage is an effective way to increase communication between providers and payers to report special circumstances with patients. Using modifers to improve claim accuracy documents the complete patient story. Gain tools and tips to help decrease rejects or denails that occur due to lack of of incorrect application of modifiers. This program has been updated to include the latest updates for 2018. Self-supplied CPT® and HCPCS Code Set manuals are required to complete practice exercises.

Jan Hailey


Jan Hailey has more than 20 years of experience in healthcare with proficiency in administration, coding, and billing roles. She joined Saint Joseph Physician Network in South Bend, Indiana as the Director of Quality in November 2015 to lead ambulatory quality initiatives and performance improvement. She leads a comprehensive interdisciplinary team across the health system and works closely with providers, management, and payers to develop strategies on process improvement, gap closures, and patient experience.

Jan also developed a documentation improvement program and is currently implementing an education program for Hierarchical Condition Category (HCC) coding in order to improve risk scores. She holds four professional certifications in office management, coding, and compliance. She is a member of WPS Medicare’s Provider Outreach and Advisory Group, Indiana Association for Healthcare Quality.

Jan has a passion for teaching and facilitates educational programs nationwide. Prior to joining Saint Joseph, Jan was the Director of Quality, Coding and Compliance for one of the largest health systems in Northern Indiana.

Federal, state and private payers report that incorrect use of modifiers is among the top reasons for billing errors. Learn correct use and ranking rules when multiple modifer categories are used. Gain examples that explain special modifer usage.  

At least one year of coding/billing experience for outpatient services is recommended.

Class Highlights:

  • Tips for correct use of -X(EPSU) modifiers
  • List and explanation of Levels I and II modifiers
  • E&M modifiers
  • HCPCS modifiers
  • Surgical Modifiers
  • Guidelines and usage tips
  • Negative impacts of modifiers
  • Sharpen knowledge of CPT® guidelines related to modifier usage
  • Why pricing modifiers are considered part of the seven-digit procedure code by CMS
  • Use of modifiers when services are in the global period
  • The difference between modifiers 25 & 59 and modifiers 52 & 53
  • Inclusion of medical necessity in documentation to support the use of modifiers
  • Audit risks and identification of abuse of modifiers as reported by CMS

On Demand course includes three hours of recorded instruction plus downloadable course materials.


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