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.

Key Points:-

• Review of modifiers from CPT and HCPCS manuals
• Learn the E/M only modifiers
• Applying modifiers when your provided did not perform the surgery
• Understand modifiers 58,59,78, and 79
• How do modifiers affect reimbursement?
• Assigning modifiers for minor and major surgery
• Appropriate use of modifier 25
• Most common modifier errors
• Medicare guidelines for modifier usage

Who Will Benefit?

Medical offices, billing companies, insurance companies, consulting firms.

• Consultants
• Auditors
• Compliance Officer
• Physician
• PA
• Nurse
• Biller
• Coder
• Collector
• Claims Representative
• Claims Adjuster
• Claims Processor
• Manager
• Supervisor
• Administrator
• Medical Assistants
• Office Staff