DecisionHealth, DecisionHealth - 2012 Issue 8 (August)

Coordinate care with ER, ‘vacation’ docs to avoid care transfer claims denials

Practices lost nearly $22 million in 2010 for denied post-operative care claims billed with modifier 55(post-operative management only) – mostly because of a lack of coordination with emergency room and out-of-town providers. The fact that a patient has to receive care from another provider out of state, poor communication between the out-of-town and local providers as well as rapid claims billing contribute to an overall 18% denial rate for Medicare claims with modifier 55 in 2010, experts say.

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