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Home > Audio Learning Center > Modifiers That Raise Red Flags

Modifiers That Raise Red Flags

Date:Tuesday, February 13, 2018
Time:12 noon to 1:00 p.m. Central Time
Course fee:SPECIAL $99 1 HR WEBINAR
Presented by: Aimee Wilcox, CPMA, CCS-P, CST, MA, MT

Webinar/Audio Conference FAQs

Audits continually reveal that many of the claims that lacked supporting documentation and were subjected to take-backs and potential accusations of fraud or abuse, included misapplication of modifiers. Among these modifiers, the most concerning to payers are for those that increase payments through the unbundling of services commonly performed together such as 24, 25 and 59.

For a number of years payers have implemented various protocols to audit claims where modifier 24 and 25 have been appended and many have failed, simply due to the fact that there weren’t enough auditors available to handle the number of claims that needed review. A closer look into many of these claims revealed that a lack of understanding of how and when these modifiers should be reported resulted in the habit of adding them to Evaluation and Management services simply because it would override any edits and ensure payment of the claim.

Modifier 59 has been such a controversial modifier that in 2015, Medicare actually released the HCPCS X {EPSU} modifiers to replace 59 when reporting services to Medicare beneficiaries. These replacement modifiers were required for reporting in place of modifier 59 but due to a lack of good examples showing how to use them, their mandatory use was temporarily postponed.

Continuing still today, many provider surgical or procedure services have inappropriately appended modifier 22 (increased procedural services), which allows an increase in payment based on the service requiring more from the provider than usually required. The use of the term, “increased” is ambiguous and as such has resulted in the inappropriate reporting and overuse of this modifier. In this webinar, we’ll teach the simple formula that when properly applied to the review of an operative report can reveal whether or not it qualifies for additional payment modifier 22.

Please join us to learn more about these important modifiers, how their use may automatically trigger scrutiny and a review of the patient record. Learn how to properly report them and ensure provider documentation supports them so you can protect your practice from unnecessary take-backs or accusations of fraud and abuse.

Continuing Education Units (CEUs)

PMI CEU APPROVED Earn 1 PMI CEUs for attendance at this program. Practice Management Institute grants CEUs for its certified professionals based on total number of instructional hours (1 CEU per hour of classroom instruction). CEUs may be applied to annual recertification requirements, as directed in the certification renewal requirements for your credential(s).

If you are seeking CEU credits for other certifications or organizations, please contact your organization for pre-approval and credit guidelines. A certificate of attendance will be provided.

Please read below before completing your webinar registration.

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Sign up now and you'll receive this webinar plus the following benefits for as long as you subscribe: access codes to all upcoming live webinars and unlimited access to the TOTAL ACCESS Library, more than 300 hours of on-demand, pre-recorded training sessions on over 100 topics relevant to medical office coding, billing, compliance, management, front desk, and much more. It's a GREAT VALUE!

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About the Presenter

Aimee is the Director of Content for Find-A-Code, an online medical billing and information database. She is a medical coding, billing, and auditing author and educator with more than 30 years of clinical and administrative healthcare experience working in a variety of specialties, in both small and large organizations. She has authored and co-authored over 40 books on ICD-10-CM and reimbursement issues, as well as authoring a successful online medical coding course. HOME | Curriculum | Locate a Class | Online Training Center | Discussion Forum | Sitemap | Policies | Contact Us!
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