tci Medicare Compliance & Reimbursement - 2024 Issue Q2

Part B Coding Coach: Avoid These 5 Modifier 59 Errors To Keep Pay Flowing

Plus: Find out the 2024 news that changes one modifier 59 rule. What would you do if 40 percent of your claims were billed incorrectly? For most providers, that would be practice-ending. Well, that’s the error rate that the HHS Office of Inspector General (OIG) found when it audited modifier 59 (Distinct procedural service) claims. A subsequent Comprehensive Error Rate Testing (CERT) report from the Centers for Medicare & Medicaid Services (CMS) revealed that $320 million in Medicare payments were linked to incorrect use of modifier 59, making it a major focus of auditor scrutiny (Source: https://www.palmettogba...

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