Consistent misuse and abuse of modifier 59 has put it on the Office of Inspector General’s active radar. Meaning payers are just waiting for you to slip up.
To make matters worse, modifier 59’s replacement X modifiers (XE, XS, XP, XU) and varying carrier guidelines, make it even more difficult to get it right. In fact, CMS Transmittal 1422 projected error rates for modifier 59 at $320 million in physician claims.
Considering the size of these projected overpayments, CMS is paying close attention and working hard to recoup this reimbursement.
So, what does this mean to you? If you’re found to be using modifier 59 incorrectly, the reimbursements you received for those services will be taken back by CMS. And if that leads to a full-scale audit of your modifier 59 claims, you could also have to pay $10,000 EACH time it was submitted on a claim. Your only defense is to act now. You need to get a firm handle on complying with modifier 59 guidelines – including modifiers – XE, XS, XP and XU, and national coding educator and auditor, Leslie Johnson, CPC, can show you how.
On Tuesday, Dec. 10th at 1 pm ET, Leslie will give you practical, step-by-step strategies for avoiding penalties for modifier 59 including:
- Principles of how and why to use modifier 59 to derail overuse penalties
- Demystify “Column 1” and “Column 2” definitions so you reduce claim errors
- Correctly apply Correct Coding Edits (CCI) 0, 1 and 9 to avoid #1 error in modifier abuse
- Map the X modifiers to your modifier 59 knowledge for easier selection
- Practical ways to differentiate E/M services modifier 25 from modifier 59 usage
- Fast track your claims with audit-proof documentation terms that support modifier 59
- Correctly apply modifiers in the right order and to the right codes to get paid accurately
- And so much more…
IMPORTANT: You may think that if you don’t bill Medicare you don’t have to worry about this but think again. Although this change is for Medicare – private insurers are quickly following suit. BlueCross Blue Shield has implemented clinical prepayment reviews in 14 states.
And remember, ignorance is not an acceptable defense against fraud violations. If you are targeted for an audit and are found to be applying modifier 59 incorrectly, or if your documentation doesn’t back up its use, you could face significant paybacks and penalties.
Don’t risk it, sign up for this must-attend training session today and finally understand these complex and dangerous modifiers. Register today.
PS: If you can’t attend this session live on the 10th, don’t worry — the full session will be recorded. Simply choose an On-demand option or CD when you order online.
Leslie received her CPC from the American Academy of Professional Coders in 2002 and recently obtained a CMCS, Certified Medical Coding Specialist from American Medical Billing Association (AMBA) in 2019. Since 2004, her career focus has consisted of multi-specialty documentation, coding, billing and contract audits for educational purposes, internal benchmarking and complex legal reviews, fee scheduling and audits. Specialty areas include anesthesia, pain management, neurosurgery, pulmonology, orthopedics, urology among others. She also a candidate for membership with the North American Spine Society (NASS). (This is being voted on Nov 15)
For the last 15 years, Leslie has been a speaker at national and local conferences for about 15 years for groups such as local AAPC chapters, Decision Health’s Advance Specialty Coding Symposium and The Coding Institute’s CodingCon national coding conferences as a subject matter expert in Anesthesia and Pain Management, Orthopedics and general medical billing and coding topics. Leslie has also done some virtual webinars for Jobs for American Medical Coders (JFAMC). Her coding articles have been published in Becker’s Online Review, BC Magazine and Find-a-Code.
In her spare time, Leslie has built and currently maintains 6 websites, including her own AskLeslie.net, and JFAMC.org, an offshoot of Facebook group Jobs for American Medical Coders, with employment tips and information shared by members of Jobs for American Medical Coders (JFAMC), which boasts over 24,000 American-based members.