DecisionHealth, DecisionHealth - 2011 Issue 12 (December)

Benchmark of the Week: 10 highest and lowest modifier denials, 2009-2010

This chart examines a total of 20 modifiers, 10 of which had some of the highest denial rates in 2010 and 10 which had some of the lowest, comparing their 2010 rates with 2009. NOTE: Because 2010 was the first year in which CMS no longer accepted consult codes (99241-99255), the new modifier AI (principal physician of record). Thus, there is no 2009 data for this modifier, which is added to inpatient claims billed by the admitting physician. Adding modifier AI lets contractors know the services were furnished by the admitting physician who coordinates care, distinguishing them from services done by others who also see the patient.

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