For decades, providers and hospitals have learned and come to understand how intertwined medical billing and coding are. Coding provides that “language of medicine” through which the physician, hospital, and insurance can communicate, or bill and pay for, services provided to patients in almost any medical setting.

The use of modifiers is an important part of coding. Modifier use has increased as payers begin to accept bills with modifiers appended because they have learned the appropriateness of the use of such modifiers to change a code description in some minor way.

CPT and HCPCS modifiers are used to supplement the information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician. Code modifiers help further describe a procedure code without changing its definition.

In this webinar, we will learn about modifiers for the following categories: E/M related, Anesthesia, Mandated and Preventive Services, Procedure and Service, Multiple Surgeon and Surgical Assistants, Professional and Technical Component, Laboratory and Pathology related, Miscellaneous, Category II, HCPCS Level II, and finally, ASC and Hospital Outpatient modifiers.

In addition to the topics above, we will also learn about modifier use and compliance through viewing useful and practical flow charts that will help you determine if the use of the modifier you are considering is appropriate and in compliance with its intended use.

Compliance is vital to understanding correct modifier use to avoid potential fraud and abuse claims. This is especially important when you bill to the Federal and State Government Programs. We will discuss the Office of the Inspector General’s (OIG) current fraud and abuse work plan and areas they are currently focusing on, as well as Compliance Plan Guidance. Another area of consideration is the owner of the Billing Company. How do you use modifiers, are they appropriate to use for the services you are billing? Are your providers maximizing their potential for reimbursement by using modifiers correctly, or are you noticing evidence of noncompliance? Have you seen credible evidence of provider misconduct when it comes to modifier use? What do you do?

Other topics we will discuss include the Affordable Care Act, Healthcare Fraud Prevention and Enforcement Action Team (HEAT), Health Insurance Portability and Accountability Act (HIPAA), The Medicare Integrity Program and payment safeguards, as well as improving healthcare industry compliance and education efforts underway by CMS and the Medicare Administrative Contractors.

We will discuss the role of the Recovery Audit Contractor (RAC) and information will be provided as to the Regional RAC by state.

Areas Covered in the Session:

• CPT and HCPCS Level II Modifiers
• Recovery Audit Contractors
• HEAT, ACA, HIPAA
• OIG Workplan Compliance
• Fraud and Abuse Prevention
• Compliance Plans for billing and coding