As anyone in the coding world knows, modifiers are a critical component for accurate billing and maximum reimbursement. The notorious complexity of modifier rules creates considerable lag when it comes to the forms review and editing process. The questions below highlight key factors that must be taken into account when applying modifiers to procedures.
The new 5010 claim standard is driving new requirements in drug reporting, specifically for drug quantity and the unit of measure.
Accurate medical coding is essential to getting paid, regardless of the method used by the physician for capturing the charge data (e.g., paper encounter forms, electronic medical record). Strictly entering the correct codes for a procedure or diagnosis is never enough. After a physician finishes documenting a patient encounter, the claim is sent to the billing office for a final review. When an encounter is in the hands of billers and coders, the complex rules of medical necessity, correct coding and carrier-specific insurance rules come into play. If a claim is denied, it is most often due to data-entry errors, gender-specific/age-specific errors, registration errors, missing modifiers, or a lack of medical necessity. Reprocessing denied claims accrues additional costs and takes away from the practice’s bottom line.