Modifier -25: Appropriate Use and Examples

Event Information
Product Format
Prerecorded Event
Elin Baklid-Kunz, MBA, CHC, CPC, CPMA, CCS
60 minutes
Product Description

Surefire Tips to Reduce the Number of Rejected Claims Due to Incorrect Use of Modifier -25

Correctly applying modifiers isn’t always as cut and dry as it seems. Many times providers inappropriately use modifiers, an abuse that inevitably leads to claim denials. Payers must pay attention to physician claims utilizing modifier 25, as it is one of the most commonly misused modifier that has a high claim denial rate.

Private payers are sending out warning letters to providers who bill E/M codes with modifiers significantly more than their peers. Increasing claim denials, wasted follow-up time, revenue loss, and OIG investigations are some of the potential consequences of inappropriate use of Modifiers.

Join Elin Baklid-Kunz, MBA, CHC, CPC, CCS, in this audio session to learn about the common Modifier -25 coding mistakes and how to ensure correct coding and payment at the first time. Learn about the current modifier trends, how to prevent reduced payments and denials and combat increased government scrutiny.

Session Highlights:

  • Compliance risk—Are you an outlier?
  • OIG’s report on modifiers
  • Appropriate use of E/M modifiers with scenarios
  • Consequences of inappropriate modifier use
  • Private payers and modifiers
  • Documentation tips to reduce the number of suspended or rejected claims
  • Sample cases and appeal letters
  • Private Payer and Appeal Resources
  • Recent fraud settlements
  • Documentation tips to win appeals

Session Snapshots:

  • OIG Work Plan—Use of modifiers during global surgery period
  • Currents audits of Modifier -25
  • Examples of inappropriate use of Modifier -25
  • Global Package vs. E/M Modifiers
  • Modifiers not used with E/M
  • More on Modifiers -25
    • Additional payment
    • Exceptions
  • CMS NCCI policy manual chapter 11
  • CMS Medicare claims processing manual
  • Global Surgery Package
    • Major
    • Minor
    • Zero Days
  • Recognizing different settings
  • Modifier -25 checklist
  • Appropriate use
    • Minor procedure & E/M service
    • Preventative service
    • Immunizations
  • Documentation requirements

Who should attend

Coding Professionals, Billing Specialist, Practice Managers, HIM Directors, Compliance Officers, Case Managers and, Physicians

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About Our Speaker

Elin Baklid Kunz - Medical Billing Coding Expert

Elin Baklid-Kunz is an expert in medical coding compliance who supports clients in matter across the United States with over 20 years of experience in the field.

Ms. Kunz is a national speaker and published author. Recent speaking engagements include the 2018 European Symposium on Ethics and Governance in Paris for the Organization of Economic Cooperation and Development; American Bar Association 2018 Physician Legal Issues Conference,  2017 American...   More Info
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