In medical coding and billing our claims sent to insurance carriers have to tell the story of what services and/or procedures were performed to treat a patient and the medical necessity the services and procedures reported. Very often circumstances arise in which we need to communicate to the insurance company that there is specific information we need to share with them for them to understand the story behind the claim. This is where the use of modifiers comes in. Modifiers tell the insurance company information that they need to further understand why a service or procedure is being reported and allows them to process the claim for reimbursement. There are also insurance company policies along with coding manual guidelines that require modifiers when certain scenarios occur. Providing the appropriate modifier(s) allows medical claims to be processed quickly so providers are not waiting for their payments. Avoiding the denial of claims is a necessary part of any revenue cycle.
Learning Objectives:-
- Identify E/M modifiers
- Discuss modifiers for services and procedures
- Learn how modifiers affect the post-operative period
- Hear about the reimbursement differences when modifiers are used
- Review scenarios in which modifiers are necessary
- Become aware of Medicare’s information related to modifiers
- X- modifiers. Are they better than 59?
- Review current documentation to determine changes that need to be made
- HCPCS modifiers available
- Modifiers related to COVID-19 you may not have previously used
Who Will Benefit?
- Medical Assistants
- Office Staff
- Prior-authorization Staff
- Consultants
- Auditors
- Compliance Officer
- Physician
- PA
- Nurse
- Biller
- Coder
- Collector
- Claims Representative
- Claims Adjuster
- Claims Processor
- Manager
- Supervisor
- Administrator
