Due to consistent over reporting and misreporting, Modifier 59 audits are on the rise… which means auditors could be knocking on your door in the near future.
To protect your practice from being a target, your only defense is to take action right away… and that’s where industry experts Leslie Johnson, CPC and Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO can help.
They have put together a 2-Part Modifier 59 Toolkit that will help you get straight answers for this tricky modifier once and for all. Your toolkit includes an upcoming live online training on Dec. 10th, and a best-selling expert report. Below is a brief description of each resource.
Order your 2-Part Training: Avoid Modifier 59 Misuse and Audits with This Expert Advice within the next 5 days, and you’ll save an additional 20% off the total cost. Discount is already reflected. No code necessary. Or, if you prefer, you can choose each session individually without the discount. ORDER TODAY!
PART 1: Protect Your Modifier 59 Pay with Correct Use Strategies
Order the downloadable version to listen at your convenience.
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.
PART 2: Modifier 59 Expert Report
Order the Printed Hard Copy OR the Downloadable PDF version.
You can’t afford to keep putting modifier 59 on every multiple code claim. Insurers have taken notice of this improper use and started invoking huge penalties.
Yes, doing your due diligence to determine if modifier 59 is appropriate takes time. But with the right strategies and practical advice, you can keep your practice out of hot water.
Carriers, Plans Increasing Modifier Monitoring
Consistent misuse and abuse of modifier 59 – $320m in claims errors – has put it on the Office of the Inspector General’s (OIG) watch list. Your carriers are actively monitoring your modifier usage and over reporting and misreporting this modifier will trigger an audit.
Anthem BlueCrossBlueShield has seen so much modifier misuse that they have rolled out prepayment claim audits in 14 states since June 2019. Nurses and coders are performing clinical reviews to check that the National Correct Coding Initiative (NCCI) edits allow using the modifier and that the scenario supports its use.
Act Now to Protect Your Practice From Penalties
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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.
Kim is an independent coding and reimbursement consultant, providing audit, training and oversight of coding and reimbursement functions for physicians. Kim completed three years of pre-medical education at the University of Alabama before she decided that she preferred the business side of medicine.
She completed a Bachelor’s degree in Health Care Management and went on to obtain certification through the American Academy of Professional Coders and the American Health Information Management Association.
Recognizing the important position of compliance in today’s world, she has also obtained certification as a Certified Healthcare Compliance Consultant and a Certified Healthcare Audit Professional. Kim is also an AHIMA-approved ICD-10-CM trainer and has recently earned a Master of Jurisprudence in Health Law.
For over twenty-five years, Kim has worked with providers in virtually all specialties, from General Surgery to Obstetrics/Gynecology to Oncology to Internal Medicine and beyond. She has spoken at the national conference for numerous organizations.