Description:
There are modifiers available to use in the CPT® and the HCPCS manual. There are modifiers that can only be used with visits, and other modifiers that are relative to surgical procedures, and others that involve DME and diagnostic testing. It is important that those that assign these modifiers understand what the description of the modifier is and what affect does it have when it is assigned due to using it incorrectly can be a compliance issue. Insurance carriers also require modifiers in some circumstances, and not assigning the modifier(s) can cause claim denial. Modifiers also describe the relationship between services and procedures being performed on the same day. Many do not understand the use of modifiers in detail that causes an automatic assignment of modifier(s), without a review of the situation, and just for reimbursement. If involved in an audit by an insurance carrier, the use of modifiers will be examined, and the misuse of modifiers could result in refunds, fines, and/or penalties.
Background:
All professional services claims for physicians and qualified healthcare professionals have requirements in order for the insurance carriers can process them for reimbursement. Modifiers may or may not be required on these claims depending on insurance carrier policies, claims edits, or specific situations in which the provider needs to alert the insurance carrier to certain circumstances. This webinar will review the most common modifiers used, and their affect on payments for these claims.
Session Highlights:
- Descriptions of modifiers in CPT and HCPCS
- Modifiers to be used for Evaluation and Management visits
- Modifiers for surgical procedures and services
- Modifiers for diagnostic testing and other services
- How do modifiers affect the post-operative period
- Reimbursement reductions due to modifiers
- Modifiers assigned for laterality
- Bilateral procedures- modifier 50 vs RT,LT
Why Should You Attend?
Modifiers can help or hinder the process of professional claims. While a provider is able to share information to the insurance carrier for consideration of the claim, and a modifier will assist in the submission of a clean claim, however, when a modifier has a specific purpose, and it is used inappropriately, it can alert insurance carriers of possible false claims that could result in audits by the insurance carriers. Some modifiers, when applied, will also affect a post-operative global period which determines when visits with the patient can be reported for reimbursement. Attendees should have an overall better understanding of how modifiers, whether using them appropriately or not, and when they can improve their overall reporting of clean claims.
Who Should Attend?
The target audience is anyone who codes and bills professional services for physicians and other qualified healthcare professionals, Coders, Billers, Physicians, Physician Assistants, Nurse Practitioners, Auditors, Collectors, Surgery Schedulers, Medical Assistants
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