tci Medicare Compliance & Reimbursement - 2007 Issue 22

FRAUD & ABUSE: Warning--Medicare Spent More Than A Billion Dollars On Improper Consults

Use modifiers in moderation, or face dire consequences.Heads up: Your use of the 25 and 59 modifiers is still on the feds' watch list.Medicare could save $538 million by reducing improper use of the 25 modifier, and $59 million by cutting back on the 59 modifier, the HHS Office of Inspector General (OIG) insists in its 2007 compendium of unimplemented recommendations. More than a third of carriers had not examined your use of the 25 modifier when the OIG issued its report on the subject in late 2005. Also, 15 percent of the time that physicians used...

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