Online Training Course

Prod ID: 276
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 when it is appropriate to use a modifier to obtain proper payment.

CEUs

3

Length

180 min

Price

$199

Modifier usage is an effective way to document the complete patient story and increase communication between providers and payers to report special circumstances with patients. The instructor will share tools and tips to improve the application of modifiers to decrease denials/rejections. Self-supplied CPT® and HCPCS manuals are required to complete practice exercises.

Linda D'Spain

CMPE, CMC, CMIS, CMOM, CMCO, CMCA-E/M


Linda is President of her medical practice management consulting firm, D'Spain Consulting. She travels the country conducting national seminars, workshops and webinars and consulting with physician practices, hospitals and medical societies on healthcare reimbursement, documentation guidelines, procedural and diagnostic coding, financial management, human resources, medical office management and compliance with fraud and abuse, OSHA, and HIPAA. She has also served as an Independent Review Organization (IRO) for the Office of the Inspector General and consulted for the Texas Medical and Dental Boards.

With more than 30 years of experience in medical practice management, Linda has managed cardiology, cardiothoracic, vascular surgery, physical therapy, orthopedics, pediatric orthopedics, gynecology and reproductive endocrinology and large multispecialty group practices. She maintained broad responsibilities in business and clinical operations, financial management, governance and organizational dynamics, human resource management, marketing, customer service, compliance, information system management, mergers and acquisitions and risk management.

Linda has attained all five PMI certifications. She also has a degree in Business Administration and is a Board Certified Medical Practice Executive through the American College of Medical Practice Executives, a member of the San Antonio Medical Group Managers Association (MGMA) and has served as an advisory board member with PMI.

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.

One year of coding/billing experience for outpatient services is recommended, but not required.

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

Self-paced online program includes unlimited review of previously recorded instruction and the downloadable course materials for 6 months.

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