The medical insurance claim CMS-1500 or the electronic equivalent explains the story of a patient encounter to the insurance carrier. CPT and ICD-10-CM codes show what procedure(s) or service(s) were performed and the reason why those were necessary. The claim paints the picture of the patient’s encounter for that day and the reason why. Coding and billing are not always black and white as circumstances and situations can occur that change the complexity or reason(s) why procedure(s) or service(s) are performed. Modifiers allow the provider of service to explain a more complete picture of the encounter in order to receive fair and proper reimbursement.
Modifiers tell different kinds of stories and affect the reimbursement of a claim in several different ways. They can cause an increase or decrease in reimbursement, extend a postoperative period, identify an area of the body, or identify extenuating circumstances. Some modifiers are required by insurance carriers in their policies to label situations for consideration on a particular claim, as well as bring attention to information related to the claim. With modifiers playing so many important roles in insurance claims, it is critical that anyone involved in creating and processing medical claims understand the modifiers found in CPT as well as HCPCS coding manuals.
Areas Covered:-
Learning Objectives:-
Background:-
Modifiers are an important part of claims billing and processing. Modifiers share information with insurance companies that would not otherwise be represented.
The misuse of modifiers can mean the difference between payment and denial as well as applying coding compliance.
Why Should You Attend:-
Anyone who assigns modifiers for coding and billing or is responsible for documenting services and procedures performed. Assigning modifiers as well as explaining why a modifier is being used can involve many staff and provider(s) in the practice.
Who Should Attend:-
Any Organization, Institution or Group User can register
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Lynn Anderanin, CPC, CPB, CPPM, CPMA, CPC-I, COSC, has over 40 years of experience in all areas of the physician practice, specializing in Orthopaedics For AAPC Lynn is currently a VILT Instructor, Workshop, and Audio Presenter. She is the founder of her Local Chapter and a former member of the NAB.
She is the Sr. Director of Coding Compliance and Education for Healthcare Information Services, a physician billing and consulting service in the Chicagoland, area. She has over 30 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Her experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology.
