New CMS Telehealth Rule: Speed Cashflow, Update Billing
Just when you thought you got your head semi-wrapped around Medicare telemedicine rules, they go and throw it out the window! On March 30, CMS issued an Interim Final Rule and released new guidance on...
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Head Off Revenue Losses Due to Shoulder Unbundling Errors
You don’t want to miss billing an allowed shoulder procedure and leave thousands of dollars on the table. But it’s imperative that you avoid shoulder unbundling errors – or your repeated billing of...
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Key to Using Modifier 25? Separate History and Exam
With the new 2021 E/M guidelines in effect, payers and auditors have made it clear that they’ll be closely scrutinizing E/M claims more than usual—this includes the modifiers appended to them as well....
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Step-by-Step Tips to Head Off Modifier 62 Overpayments
The January 2021 updated OIG Work Plan makes it clear that the Office of the Inspector General (OIG) is paying attention to surgical modifier 62. The Work Plan states.billing modifier 62. “…we plan to...
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Modifier 58 vs 78: Boost Pay-up for Post-Op Procedures
Using modifier 58 to code post-operative procedures can prevent payer denials and decreased reimbursement for services – but you must use it correctly. When coding post-op procedures, most problems...
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Cigna Delays Plan Requiring Medical Records With Modifier 25
UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare...
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4 Uses of Modifier 59 That Are Appropriate (And 2 That Aren’t)
Whether or not you have a solid understanding of the National Correct Coding Initiative (NCCI) edits, you are likely very familiar with modifier 59 and the X modifiers, which allow you to report two...
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3 Ways Payers Are Monitoring Your Use of CPT Modifiers
Without CPT modifiers, many coders would struggle to submit accurate claims to payers. Why? Because modifiers allow you to provide insurers with more information about a service or supply, without...
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3 Modifier 25 Best Practices to Keep Your E/M Pay Flowing
Every minor procedure your providers perform includes an inherent evaluation and management (E/M) portion factored into the reimbursement for it. But when you go beyond that cursory E/M work, you...
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Real-World Examples Guide When to Use RT and LT Modifiers
If you’ve ever coded a patient chart, you know about the LT (Left side) and RT (Right side) modifiers. Together, the RT and LT modifiers are used to show laterality — in other words, they describe...
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